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Organization
S. ADIMOOLAM, PHYSICIAN, PC
Active
Organization
S. ADIMOOLAM, PHYSICIAN, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBRA PRUCHA (OFFICE MANAGER)
(718) 494-4934
Entity
Organization
Contact information
Practice address
1756 RICHMOND AVE, STATEN ISLAND, NY 10314-3902
(718) 494-3383
(718) 494-1705
Mailing address
1756 RICHMOND AVE, STATEN ISLAND, NY 10314-3902
(718) 494-3383
(718) 494-1705
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
NYS121313
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0019584
GROUP HEALTH INSURANCE
NY
05
—
00440597
—
NY
01
—
OC1723
PHC
NY
01
—
OS053
OXFORD HEALTH PLANS
NY
Enumeration date
11/07/2006
Last updated
08/18/2008
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