Healthcare Provider Details

I. General information

NPI: 1386822922
Provider Name (Legal Business Name): JYOTI KINI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 02/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 WESTCHESTER AVE
BRONX NY
10461-4509
US

IV. Provider business mailing address

3251 WESTCHESTER AVENUE DOC MEDICAL OFFICE OF BRONX
BRONX NY
10461
US

V. Phone/Fax

Practice location:
  • Phone: 718-792-7600
  • Fax: 718-792-3903
Mailing address:
  • Phone: 718-792-7600
  • Fax: 718-792-3903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number247314
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: