Organization
CHENNAREDDY MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RAEFEAL NOAH LUKE (ADMINISTRATIVE SECRETARY)
(646) 883-0422
Entity
Organization
Contact information
Practice address
10105 LEFFERTS BLVD STE 203, SOUTH RICHMOND HILL, NY 11419-2014
(718) 441-8086
(718) 250-6036
Mailing address
30 PURITAN AVE, FOREST HILLS, NY 11375-6029
(718) 250-8866
(718) 250-6703
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
112288
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00203118
—
NY
Enumeration date
07/19/2006
Last updated
05/02/2024
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