Individual
DR. DIVYA ADUSUMILLI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DD
Contact information
Practice address
285 FORT WASHINGTON AVE, CD, NEW YORK, NY 10032-1206
(212) 795-9675
Mailing address
527 E 72ND ST, APT 1CD2D, NEW YORK, NY 10021-4011
(212) 734-2959
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
052896-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02622604
—
NY
05
—
02820973
—
NY
Enumeration date
05/02/2007
Last updated
07/09/2007
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