Individual
NAGABHUSHANA NIMMAGADDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
80 MARCUS DR, PROVIDER ENROLLMENT DEPARTMENT, MELVILLE, NY 11747-4230
(631) 391-7887
(631) 454-4163
Mailing address
1900 HEMPSTEAD TURNPIKE, SUITE 500, EAST MEADOW, NY 11554
(516) 542-1090
(516) 794-8165
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
149316
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00763502
—
NY
Enumeration date
10/27/2006
Last updated
12/01/2015
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