Healthcare Provider Details

I. General information

NPI: 1124011366
Provider Name (Legal Business Name): KISHORE N RANADE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 02/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

672 STONELEIGH AVE
CARMEL NY
10512-3997
US

IV. Provider business mailing address

672 STONELEIGH AVE
CARMEL NY
10512-3997
US

V. Phone/Fax

Practice location:
  • Phone: 845-279-9000
  • Fax: 845-279-4141
Mailing address:
  • Phone: 845-279-9000
  • Fax: 845-279-4141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA1693881
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number029705
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number169388
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: