Basic Information
| Provider Information | |||||||||
| NPI: | 1194815282 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NAGAROOPA | ||||||||
| FirstName: | BANGALORE | ||||||||
| MiddleName: | RANGASWAMY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 152 HUNGRY HARBOR RD | ||||||||
| Address2: | |||||||||
| City: | VALLEY STREAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115812515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165690942 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1650 SELWYN AVE | ||||||||
| Address2: | SUITE 6D | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104577626 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7189601415 | ||||||||
| FaxNumber: | 7185185124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 05/10/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0204X | 115629 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine | 208000000X | 115629 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 00832471 | 05 | NY | MEDICAID |