Healthcare Provider Details

I. General information

NPI: 1356531883
Provider Name (Legal Business Name): MAMTA M. MAMIK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DR. MAMTA M. KULKARNI

II. Dates (important events)

Enumeration Date: 07/31/2007
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PELHAM PKWY S BLDG 1, ROOM BS27
BRONX NY
10461-1119
US

IV. Provider business mailing address

1400 PELHAM PKWY S BLDG 1, ROOM BS27
BRONX NY
10461-1119
US

V. Phone/Fax

Practice location:
  • Phone: 914-721-3359
  • Fax:
Mailing address:
  • Phone: 914-721-3359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number4301085885
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number267923
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD2009-0223
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: