Healthcare Provider Details

I. General information

NPI: 1225297112
Provider Name (Legal Business Name): RUKMINI S KENIA MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 SPRINGFIELD ROAD
WESTFIELD MA
01085
US

IV. Provider business mailing address

65 SPRINGFIELD ROAD
WESTFIELD MA
01085
US

V. Phone/Fax

Practice location:
  • Phone: 413-562-8330
  • Fax: 413-562-3430
Mailing address:
  • Phone: 413-562-8330
  • Fax: 413-562-3430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number52732
License Number StateMA

VIII. Authorized Official

Name: MRS. RUKMINI S KENIA
Title or Position: MD
Credential: MD
Phone: 413-562-8330