Healthcare Provider Details

I. General information

NPI: 1710680913
Provider Name (Legal Business Name): PANKUSH KUMAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6940 MAIN ST
FLUSHING NY
11367-1723
US

IV. Provider business mailing address

6940 MAIN ST
FLUSHING NY
11367-1723
US

V. Phone/Fax

Practice location:
  • Phone: 718-880-2050
  • Fax:
Mailing address:
  • Phone: 718-470-8284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number344428
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: