Healthcare Provider Details

I. General information

NPI: 1417575911
Provider Name (Legal Business Name): KUMAR MEDICAL PAIN MANAGEMENT PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2020
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 OLD COUNTRY RD
PLAINVIEW NY
11803-4914
US

IV. Provider business mailing address

25629 UNION TPKE UNIT 40043
GLEN OAKS NY
11004-1251
US

V. Phone/Fax

Practice location:
  • Phone: 516-823-6570
  • Fax:
Mailing address:
  • Phone: 516-229-1640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ASHISH KUMAR
Title or Position: PHYSICIAN
Credential: DO
Phone: 516-823-6570