Healthcare Provider Details

I. General information

NPI: 1780320580
Provider Name (Legal Business Name): NATASHA WAI KASULIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date: 12/13/2022
Reactivation Date: 04/28/2023

III. Provider practice location address

1276 FULTON AVE
BRONX NY
10456-3467
US

IV. Provider business mailing address

1276 FULTON AVE
BRONX NY
10456-3467
US

V. Phone/Fax

Practice location:
  • Phone: 718-992-7669
  • Fax:
Mailing address:
  • Phone: 718-992-7669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number344727
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: