Healthcare Provider Details

I. General information

NPI: 1497958060
Provider Name (Legal Business Name): JK JOHN KINNALLY RASAMNY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 SAW MILL RIVER RD SUITE 101
ARDSLEY NY
10502-1045
US

IV. Provider business mailing address

1055 SAW MILL RIVER RD SUITE 101
ARDSLEY NY
10502-1045
US

V. Phone/Fax

Practice location:
  • Phone: 914-693-7636
  • Fax:
Mailing address:
  • Phone: 914-693-7636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number271706
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: