Healthcare Provider Details

I. General information

NPI: 1154324127
Provider Name (Legal Business Name): KUMAR SIVA KALAPATAPU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 12/30/2022
Certification Date: 12/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE STE 700
HAWTHORNE NY
10532-2140
US

IV. Provider business mailing address

630 W 168TH ST # 4
NEW YORK NY
10032-3725
US

V. Phone/Fax

Practice location:
  • Phone: 914-593-7800
  • Fax: 914-593-7857
Mailing address:
  • Phone: 212-305-9817
  • Fax: 914-593-7881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number207037
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number207037
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: