Healthcare Provider Details

I. General information

NPI: 1760484265
Provider Name (Legal Business Name): ASHUTOSH KAUL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 12/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 BRADHURST AVE
HAWTHORNE NY
10532-2140
US

IV. Provider business mailing address

19 BRADHURST AVE STE 1700
HAWTHORNE NY
10532-2139
US

V. Phone/Fax

Practice location:
  • Phone: 914-347-0162
  • Fax: 914-347-4401
Mailing address:
  • Phone: 914-347-0162
  • Fax: 914-347-4401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number217264
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number217264
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: