| 43rd St Family Practice Pllc | |
|
4543 43rd St Sunnyside NY 11104-2609 | |
| (718) 392-2220 | |
| Not Available |
| Full Name | 43rd St Family Practice Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 4543 43rd St, Sunnyside, New York |
| Authorized Official Name and Position | Durga Maddineni (MD) |
| Authorized Official Contact | 7183922220 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 43rd St Family Practice Pllc 4543 43rd St Sunnyside NY 11104-2609 Ph: (718) 392-2220 | 43rd St Family Practice Pllc 4543 43rd St Sunnyside NY 11104-2609 Ph: (718) 392-2220 |
| NPI Number | 1194830265 |
|---|---|
| Provider Enumeration Date | 08/20/2006 |
| Last Update Date | 03/31/2016 |
| Medicare PECOS PAC ID | 2860499860 |
|---|---|
| Medicare Enrollment ID | O20061106000266 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194830265 | NPI | - | NPPES |
| 02462119 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 227095 (New York) | Primary |
| Provider Name | Durga Maddineni |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548209943 PECOS PAC ID: 3678565801 Enrollment ID: I20040330001455 |
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