Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 114601 | NY |
N | 111NI0900X | Internist | 114601 | NY |
N | 207RC0000X | Internist - Cardiovascular Disease | 114601 | NY |
N | 207RG0300X | Geriatric Medicine | 114601 | NY |
NPI | 1124235221 |
---|---|
Provider Name | Venkatachala Pathy |
First Address | Bronx, NY 10461-3733 |
Second Address | Bronx, NY 10461-3733 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00424575 | (05) | NY |
A63904 | (02) | NY |