Healthcare Provider Details

I. General information

NPI: 1871798330
Provider Name (Legal Business Name): POKALA R KIRAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 FORT WASHINGTON AVE FL 8
NEW YORK NY
10032-3729
US

IV. Provider business mailing address

161 FORT WASHINGTON AVE FL 8
NEW YORK NY
10032-3729
US

V. Phone/Fax

Practice location:
  • Phone: 212-342-1161
  • Fax: 212-305-0267
Mailing address:
  • Phone: 212-342-1155
  • Fax: 212-305-0267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number269812-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: