Basic Information
| Provider Information | |||||||||
| NPI: | 1679674915 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PARITHIVEL | ||||||||
| FirstName: | VELLORE | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 707 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109402650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453331114 | ||||||||
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| Practice Location | |||||||||
| Address1: | 707 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109402650 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8453331114 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2006 | ||||||||
| LastUpdateDate: | 10/19/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 135004 | NY | N | Other Service Providers | Specialist | 2086S0127X | 135004 | NY | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 2086S0102X | 135004 | NY | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 208600000X | 135004 | NY | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00607621 | 05 | NY | MEDICAID |