Nerlige Basavaraju Physician, P.c. | |
68 Hauppauge Rd Commack NY 11725-4403 | |
(516) 713-4465 | |
Not Available |
Full Name | Nerlige Basavaraju Physician, P.c. |
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Speciality | Internal Medicine |
Location | 68 Hauppauge Rd, Commack, New York |
Authorized Official Name and Position | Nerlige Basavaraju (CEO) |
Authorized Official Contact | 5167134465 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Nerlige Basavaraju Physician, P.c. 378 Elm Dr Roslyn NY 11576-3013 Ph: (516) 713-4465 | Nerlige Basavaraju Physician, P.c. 68 Hauppauge Rd Commack NY 11725-4403 Ph: (516) 713-4465 |
NPI Number | 1427576370 |
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Provider Enumeration Date | 08/30/2017 |
Last Update Date | 08/30/2017 |
Medicare PECOS PAC ID | 5698049526 |
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Medicare Enrollment ID | O20170915002591 |
Identifier | Type | State | Issuer |
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1427576370 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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207R00000X | Internal Medicine | 117319 (New York) | Primary |
Provider Name | Nerlige Basavaraju |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1205827680 PECOS PAC ID: 6305828161 Enrollment ID: I20040604000326 |
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