Healthcare Provider Details

I. General information

NPI: 1154128429
Provider Name (Legal Business Name): PREETI KAKKAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2025
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E 68TH ST
NEW YORK NY
10065-4870
US

IV. Provider business mailing address

313 CREEK DR APT 58
RADNOR PA
19087-5225
US

V. Phone/Fax

Practice location:
  • Phone: 212-746-4580
  • Fax: 212-746-9010
Mailing address:
  • Phone: 916-750-6911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number2003511052
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: