Healthcare Provider Details

I. General information

NPI: 1184764359
Provider Name (Legal Business Name): DIABETES & ENDOCRINOLOGY CONSULTANTS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CROSFIELD AVE SUITE 204
WEST NYACK NY
10994-2226
US

IV. Provider business mailing address

2 CROSFIELD AVE SUITE 204
WEST NYACK NY
10994-2226
US

V. Phone/Fax

Practice location:
  • Phone: 845-358-6266
  • Fax: 845-358-7872
Mailing address:
  • Phone: 845-358-6266
  • Fax: 845-358-7872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number173152
License Number StateNY

VIII. Authorized Official

Name: DR. KAMINI SHREEDHAR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 845-358-6266