Healthcare Provider Details

I. General information

NPI: 1144280538
Provider Name (Legal Business Name): SAMPATH RAMASAMY KUMAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2006
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7517 6TH AVE
BROOKLYN NY
11209-3315
US

IV. Provider business mailing address

7517 6TH AVE
BROOKLYN NY
11209-3315
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-5777
  • Fax: 718-630-5790
Mailing address:
  • Phone: 718-630-5777
  • Fax: 718-630-5790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number140466
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number140466
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: