Healthcare Provider Details

I. General information

NPI: 1912897273
Provider Name (Legal Business Name): KISHAL JAGDISH ACHARYA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9114 MERRICK BLVD FL 6
JAMAICA NY
11432-5363
US

IV. Provider business mailing address

9114 MERRICK BLVD FL 6
JAMAICA NY
11432-5363
US

V. Phone/Fax

Practice location:
  • Phone: 718-722-6001
  • Fax:
Mailing address:
  • Phone: 718-722-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: