Organization
RIVERSIDE MEDICAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUDHAKAR REDDY METTU M.D. (PRESIDENT)
(914) 968-3535
Entity
Organization
Contact information
Practice address
1010 N BROADWAY, YONKERS, NY 10701-1303
(914) 968-3535
(914) 968-3566
Mailing address
1010 N BROADWAY, YONKERS, NY 10701-1303
(914) 968-3535
(914) 968-3566
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
158051
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02544136
—
NY
Enumeration date
06/17/2006
Last updated
04/16/2008
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