Healthcare Provider Details

I. General information

NPI: 1639663479
Provider Name (Legal Business Name): KULDEEP SINGH MEDICINE AND SURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

761 MIDDLE COUNTRY RD
SELDEN NY
11784-2550
US

IV. Provider business mailing address

8 IRIS RD
SUMMIT NJ
07901-1406
US

V. Phone/Fax

Practice location:
  • Phone: 631-736-4064
  • Fax: 631-736-1332
Mailing address:
  • Phone: 917-538-2643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number251832
License Number StateNY

VIII. Authorized Official

Name: KULDEEP SINGH
Title or Position: OWNER/CEO
Credential: MD
Phone: 917-538-2643