Healthcare Provider Details

I. General information

NPI: 1902349822
Provider Name (Legal Business Name): MANIMARAN KALIAMURTHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/25/2016
Last Update Date: 03/19/2023
Certification Date: 03/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 1ST AVE METROPOLITAN HOSPITAL CENTER DEPARTMENT OF NEPHROLOGY
NEW YORK NY
10029-7404
US

IV. Provider business mailing address

1901 1ST AVE METROPOLITAN HOSPITAL CENTER DEPARTMENT OF NEPHROLOGY
NEW YORK NY
10029-7404
US

V. Phone/Fax

Practice location:
  • Phone: 212-423-6271
  • Fax:
Mailing address:
  • Phone: 212-423-6271
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number313610
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number313610
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: