MEDICARE: NANJUNDAIAH KUMAR MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RA0201X	Allergy & Immunology (Internal Medicine) Physician	188703	NY

General Provider Information

NPI Number	:	1093745556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANJUNDAIAH KUMAR MD

Provider Business Mailing Address
First Line	:	424 JEROME CT
Second Line	:
City	:	SYOSSET
State	:	NY
Zip	:	11791-5401
Country	:	US
Telephone Number	:	718-760-1100
Fax Number	:	718-732-2120

Provider Business Practice Location Address
First Line	:	3506 73RD STREET CELLAR #2
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372
Country	:	US
Telephone Number	:	718-760-1100
Fax Number	:	718-732-2120

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	02/16/2015

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