Mrudula Premkumar, M.D

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

299538 Issued in NY

Practice address

160 N Midland Ave
Nyack, NY 10960-1912

Phone

(973) 615-6662

NPI assigned

Aug 22, 2016

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Mrudula Maddali Former name

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Inpatient Medical Associates of New York PLLC

  • Pediatric Emergency Medicine (Emergency Medicine) Physician
  • Nyack, NY
  • NPI 1063717791
  Medicare reassignment
• Montefiore Nyack Hospital

  • General Acute Care Hospital
  • Nyack, NY
  • NPI 1104808062
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1471824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581638400000",
    "number": "1225583180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "61 DAVIS AVE APT Q",
            "city": "WHITE PLAINS",
            "state": "NY",
            "postal_code": "106051009",
            "telephone_number": "973-615-6662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 N MIDLAND AVE",
            "city": "NYACK",
            "state": "NY",
            "postal_code": "109601912",
            "telephone_number": "973-615-6662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PREMKUMAR",
        "first_name": "MRUDULA",
        "name_prefix": "Dr.",
        "credential": "M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-22",
        "last_updated": "2020-02-14",
        "certification_date": "2020-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "299538",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MRUDULA",
            "last_name": "MADDALI",
            "prefix": "DR.",
            "credential": "M.D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nikki Poliey
• Perel Politzer
• Polly Corman Inc
• Octavian Popa, MD
• Gloria Porcelli
• Cami Sienna Presha-Wendel, LMHC
• Debra Janette Pritzker, P.A.
• Nancy Vanessa Quiroz Gomez, RN
• Ira Rabinowitz, RPH
• Michael E Rader, M.D.

• Pediatrics Physician in Nyack, NY
• Providers in Nyack, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.