Healthcare Provider Details

I. General information

NPI: 1184462079
Provider Name (Legal Business Name): DEEPAM KUNDAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2024
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10-42 MITCHELL AVE
BINGHAMTON NY
13903-1678
US

IV. Provider business mailing address

33-57 HARRISON ST
JOHNSON CITY NY
13790-2174
US

V. Phone/Fax

Practice location:
  • Phone: 607-772-8772
  • Fax:
Mailing address:
  • Phone: 607-763-6075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: