Healthcare Provider Details

I. General information

NPI: 1336671288
Provider Name (Legal Business Name): VIVEK KUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 01/28/2025
Certification Date: 01/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 BROADWAY STE 106
AMITYVILLE NY
11701-2260
US

IV. Provider business mailing address

6145 98TH ST APT 10G
REGO PARK NY
11374-1465
US

V. Phone/Fax

Practice location:
  • Phone: 855-295-4144
  • Fax:
Mailing address:
  • Phone: 203-863-3409
  • Fax: 203-863-3446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number307429
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: