Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 248728 | NY |
N | 111NI0900X | Internist | 248728 | NY |
Y | 207RC0000X | Internist - Cardiovascular Disease | 248728 | NY |
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 248728 | NY |
NPI | 1245453018 |
---|---|
Provider Name | Dr. Bharath Mettu Reddy |
First Address | Brooklyn, NY 11215-3609 |
Second Address | Brooklyn, NY 11215-3609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 06/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I74170 | (02) |