Healthcare Provider Details

I. General information

NPI: 1285830406
Provider Name (Legal Business Name): ISLAND ALLERGY & ASTHMA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 03/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 73RD ST CELLAR #2
JACKSON HEIGHTS NY
11372-4148
US

IV. Provider business mailing address

424 JEROME CT
SYOSSET NY
11791-5401
US

V. Phone/Fax

Practice location:
  • Phone: 718-760-1100
  • Fax: 718-732-2120
Mailing address:
  • Phone: 718-760-1100
  • Fax: 718-760-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number188703
License Number StateNY

VIII. Authorized Official

Name: DR. NANJUNDAIAH S KUMAR
Title or Position: OWNER
Credential: M.D
Phone: 718-760-1100