Healthcare Provider Details

I. General information

NPI: 1083870588
Provider Name (Legal Business Name): KENNETH RASALAN DULNUAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SEAVIEW AVE STE 300
STATEN ISLAND NY
10305-3400
US

IV. Provider business mailing address

8813 RIDGE BLVD FL 1
BROOKLYN NY
11209-5613
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-3202
  • Fax: 718-226-7091
Mailing address:
  • Phone: 315-395-8014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number45759
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA10692000
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number338375
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA10692000
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number45759
License Number StateKY
# 6
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number338375
License Number StateNY
# 7
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number25MA10692000
License Number StateNJ
# 8
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number338375
License Number StateNY
# 9
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number45759
License Number StateKY
# 10
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number25MA10692000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: