Active NPI
Praveen Choudari Vallabhaneni, DMD
- Dentist
- Troy, NY
National Provider Identifier
1467516179
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 047092
- Practice address
- 333 Hoosick St
Troy, NY 12180 - Phone
- (518) 274-7001
- Fax
- (518) 274-7016
- NPI assigned
- Dec 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 047092 | NY | Primary |
Addresses
Primary practice location
333 Hoosick St
Troy, NY 12180
Mailing address
333 Hoosick St
Troy, NY 12180
Phone (518) 274-7001
Medicare participation
Medicare enrollment files- 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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150603001937 | NY | Order and Referring Only - Dentist | 3375864234 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 047092 | NY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166572800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1467516179",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "333 HOOSICK ST",
"city": "TROY",
"state": "NY",
"postal_code": "12180",
"telephone_number": "518-274-7001",
"fax_number": "518-274-7016"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "333 HOOSICK ST",
"city": "TROY",
"state": "NY",
"postal_code": "12180",
"telephone_number": "518-274-7001",
"fax_number": "518-274-7016"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VALLABHANENI",
"first_name": "PRAVEEN",
"middle_name": "CHOUDARI",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-20",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "047092",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Troy, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.