Healthcare Provider Details

I. General information

NPI: 1790597052
Provider Name (Legal Business Name): KAILASH CHANDRA SAXENA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2025
Last Update Date: 01/23/2025
Certification Date: 01/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 E 149TH ST
BRONX NY
10455-4670
US

IV. Provider business mailing address

216 N 2ND ST
BETHPAGE NY
11714-2104
US

V. Phone/Fax

Practice location:
  • Phone: 718-583-7736
  • Fax: 844-457-7750
Mailing address:
  • Phone: 516-503-1179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberP133543
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberP133543
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: