Healthcare Provider Details

I. General information

NPI: 1215869276
Provider Name (Legal Business Name): JERICHO NEPHROLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 TIOGA DR
JERICHO NY
11753-1930
US

IV. Provider business mailing address

14 TIOGA DR
JERICHO NY
11753-1930
US

V. Phone/Fax

Practice location:
  • Phone: 917-302-3909
  • Fax:
Mailing address:
  • Phone: 917-302-3909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MANDEEP KAUR
Title or Position: OWNER
Credential: MD
Phone: 917-302-3909