Healthcare Provider Details

I. General information

NPI: 1922046069
Provider Name (Legal Business Name): KANWALWIR SANGHERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 09/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 NORTH STREET SUITE 407
WHITE PLAINS NY
10605-2217
US

IV. Provider business mailing address

311 NORTH STREET SUITE 407
WHITE PLAINS NY
10605-2217
US

V. Phone/Fax

Practice location:
  • Phone: 914-287-7617
  • Fax: 914-287-7618
Mailing address:
  • Phone: 914-287-7617
  • Fax: 914-287-7618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number184646
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number184646
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: