Healthcare Provider Details

I. General information

NPI: 1447628342
Provider Name (Legal Business Name): KUMAR PHYSICIAN OFFICE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 12/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25012 HILLSIDE AVE STE B
BELLEROSE NY
11426-2139
US

IV. Provider business mailing address

13 WILTON ST
NEW HYDE PARK NY
11040-3829
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-0126
  • Fax: 718-470-0128
Mailing address:
  • Phone: 718-470-0126
  • Fax: 718-470-0128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number265895
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number265895
License Number StateNY

VIII. Authorized Official

Name: DR. MANISH KUMAR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-470-0126