Provider Demographics
NPI:1447817077
Name:SENGUTTUVAN, NAGENDRA BOOPATHY
Entity type:Individual
Prefix:
First Name:NAGENDRA BOOPATHY
Middle Name:
Last Name:SENGUTTUVAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508, HORIZON RESIDENCES
Mailing Address - Street 2:16/1 ARUNCHALAM ROAD, SALIGRAM
Mailing Address - City:CHENNAI
Mailing Address - State:TAMIL NADU
Mailing Address - Zip Code:600095
Mailing Address - Country:IN
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 GUSTAVE L LEVY PL
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6504
Practice Address - Country:US
Practice Address - Phone:212-241-3419
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP86716207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology