Healthcare Provider Details

I. General information

NPI: 1093745556
Provider Name (Legal Business Name): NANJUNDAIAH KUMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 02/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 73RD STREET CELLAR #2
JACKSON HEIGHTS NY
11372
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: 718-732-2120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number188703
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: