Provider Demographics
NPI:1538421946
Name:SARALA K REDDY MD. PC.
Entity type:Organization
Organization Name:SARALA K REDDY MD. PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:SANDIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-784-7803
Mailing Address - Street 1:755 PARK AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3975
Mailing Address - Country:US
Mailing Address - Phone:631-784-7803
Mailing Address - Fax:631-784-7814
Practice Address - Street 1:755 PARK AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743
Practice Address - Country:US
Practice Address - Phone:631-784-7803
Practice Address - Fax:631-784-7814
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-12
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00168136103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA60360Medicare UPIN