Healthcare Provider Details

I. General information

NPI: 1437539897
Provider Name (Legal Business Name): DAVINDER KUMAR MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 06/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE
NEW HYDE PARK NY
11040-1402
US

IV. Provider business mailing address

12 LENMORE DR
OLD BETHPAGE NY
11804-1119
US

V. Phone/Fax

Practice location:
  • Phone: 646-944-5556
  • Fax:
Mailing address:
  • Phone: 646-944-5556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number253512
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number253512
License Number StateNY

VIII. Authorized Official

Name: DR. DAVINDER KUMAR
Title or Position: OWNER
Credential: MD
Phone: 646-944-5556