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Contact Information

NAGABHUSHANA NIMMAGADDA
80 MARCUS DR
PROVIDER ENROLLMENT DEPARTMENT
MELVILLE, NY11747-4230
 Phone: 631-391-7887
 Fax: 631-454-4163
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Anatomic Pathology & Clinical Pathology

207ZP0102X 22 Physician/Pathology
Indicates primary specialty

NPI Profile & details for NAGABHUSHANA NIMMAGADDA · (Male)

NPI # 1750467494
Status Active
Credentials
Entity Individual
Enumeration date 10/27/2006
Last updated 12/01/2015 - About 11 years ago
Sole proprietor 1 No
Identifiers
  • NY License # 149316
  • NY Medicaid 00763502
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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