Basic Information
| Provider Information | |||||||||
| NPI: | 1629226279 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KORABATHINA | ||||||||
| FirstName: | PUJA | ||||||||
| MiddleName: | ROOPA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MAHINDRA | ||||||||
| OtherFirstName: | PUJA | ||||||||
| OtherMiddleName: | ROOPA | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 101 W 15TH ST | ||||||||
| Address2: | APARTMENT 6NS | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100116700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122299722 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1621 EASTCHESTER RD | ||||||||
| Address2: | DEPARTMENT OF MEDICINE | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104612604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184058040 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2008 | ||||||||
| LastUpdateDate: | 09/25/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 246222 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.