Basic Information
| Provider Information | |||||||||
| NPI: | 1275719205 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHINNAPPALA | ||||||||
| FirstName: | SWAROOPA | ||||||||
| MiddleName: | SANGAMESH | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 WATER ST | ||||||||
| Address2: | 2ND FLOOR CRED DEPT | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100410004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6466802888 | ||||||||
| FaxNumber: | 5165425556 | ||||||||
| Practice Location | |||||||||
| Address1: | 20620 LINDEN BLVD | ||||||||
| Address2: | |||||||||
| City: | CAMBRIA HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114111524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184796600 | ||||||||
| FaxNumber: | 7182173546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2008 | ||||||||
| LastUpdateDate: | 09/10/2019 | ||||||||
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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 | 207R00000X | 246688 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9255YN | 01 | NY | MEDICARE ID | OTHER | 02957537 | 05 | NY | MEDICAID |