Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0011X | Interventional Cardiology | 283789 | NY |
NPI | 1083957021 |
---|---|
Provider Name | Dr. Gaurav Jerripotula Rao |
First Address | Manhasset, NY 11030-3816 |
Second Address | Manhasset, NY 11030-3816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2013 |
Last Update Date | 22/06/2020 |