Healthcare Provider Details

I. General information

NPI: 1689063281
Provider Name (Legal Business Name): PUSHPA KUMARI YADAV M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2015
Last Update Date: 02/13/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36-11 21ST ST
LONG ISLAND CITY NY
11106-4505
US

IV. Provider business mailing address

60 MADISON AVE FL 5
NEW YORK NY
10010-1600
US

V. Phone/Fax

Practice location:
  • Phone: 718-482-7772
  • Fax: 718-482-9648
Mailing address:
  • Phone: 212-545-2400
  • Fax: 212-463-8411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberV1922
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2202-C
License Number StateAS
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberV1922
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number331091
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: