Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 139685 | NY |
NPI | 1003854654 |
---|---|
Provider Name | Dr. Thulasi Cheruvanky |
First Address | New York, NY 10041-0004 |
Second Address | Hicksville, NY 11801-5006 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2006 |
Last Update Date | 10/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01297438 | (05) | NY |
B14250 | (02) | NY |