Provider Demographics
NPI:1447336755
Name:ADIMOOLAM, SEETHARAMAN (MD, PC)
Entity type:Individual
Prefix:
First Name:SEETHARAMAN
Middle Name:
Last Name:ADIMOOLAM
Suffix:
Gender:M
Credentials:MD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1756 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3902
Mailing Address - Country:US
Mailing Address - Phone:718-494-3383
Mailing Address - Fax:718-494-1705
Practice Address - Street 1:1756 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3902
Practice Address - Country:US
Practice Address - Phone:718-494-3383
Practice Address - Fax:718-494-1705
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNYS 121313174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY25A413OtherEMPIRE BC/BS
NYOC1723OtherHEALTHNET
NY252780301OtherHEALTH PLUS
NYOS053OtherOXFORD HEALTH PLANS
NY25A411OtherEMPIRE BC/BS
NY0019584OtherGHI
NY00440597Medicaid
NY252780301OtherHEALTH PLUS
NY0019584OtherGHI
NY25A413OtherEMPIRE BC/BS