Individual
PRADEEPA ARIVAZHAGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6995 QUEENS MIDTOWN EXPY, MASPETH, NY 11378-1922
(609) 647-6038
Mailing address
4545 40TH ST APT 3R, SUNNYSIDE, NY 11104-3919
(609) 647-6038
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
P100907
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P100907
UNIVERSITY OF THE STATE OF NEW YORK, THE STATE EDUCATION DEPARTMENT
NY
Enumeration date
06/27/2019
Last updated
06/28/2019
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