| Chennareddy Md Pc | |
|
10105 Lefferts Blvd Ste 203 South Richmond Hill NY 11419-2014 | |
| (718) 441-8086 | |
| (718) 250-6036 |
| Full Name | Chennareddy Md Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 10105 Lefferts Blvd Ste 203, South Richmond Hill, New York |
| Authorized Official Name and Position | Raefeal Noah Luke (ADMINISTRATIVE SECRETARY) |
| Authorized Official Contact | 6468830422 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chennareddy Md Pc 30 Puritan Ave Forest Hills NY 11375-6029 Ph: (718) 250-8866 | Chennareddy Md Pc 10105 Lefferts Blvd Ste 203 South Richmond Hill NY 11419-2014 Ph: (718) 441-8086 |
| NPI Number | 1356360382 |
|---|---|
| Provider Enumeration Date | 07/19/2006 |
| Last Update Date | 05/02/2024 |
| Medicare PECOS PAC ID | 3072404151 |
|---|---|
| Medicare Enrollment ID | O20051104000118 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356360382 | NPI | - | NPPES |
| 00203118 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 112288 (New York) | Primary |
| Provider Name | Swaminathan Chennareddy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508895251 PECOS PAC ID: 0941243653 Enrollment ID: I20050603000550 |
| Provider Name | Xuemei He |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245534940 PECOS PAC ID: 5799949491 Enrollment ID: I20120608000393 |
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