Healthcare Provider Details

I. General information

NPI: 1902880255
Provider Name (Legal Business Name): SMITA RAJEEV KUMAR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4350 VAN CORTLANDT PARK E
BRONX NY
10470-1875
US

IV. Provider business mailing address

6 PHEASANT RUN
SCARSDALE NY
10583-3141
US

V. Phone/Fax

Practice location:
  • Phone: 718-231-6565
  • Fax: 718-231-8477
Mailing address:
  • Phone: 718-231-6565
  • Fax: 718-231-8477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number163227
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: