Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 123442 | NY |
NPI | 1912089400 |
---|---|
Provider Name | Dr. Nydia M Reddy |
First Address | Brooklyn, NY 11207-3509 |
Second Address | Brooklyn, NY 11207-3509 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H64849 | (02) | NY |