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General NPI Number Information
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NPI Number | 1134176662
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Entity Type | Organization
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Legal Business Name | ADVANCED OTOLARYNGOLOGY, PC
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Dates
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Enumeration Date | 05/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 877 STEWART AVE SUITE 2
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City | GARDEN CITY
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State | NY
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Zip | 11530-4803
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Country | US
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Telephone | 516-222-1105
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Fax | 516-222-1161
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Provider Business Mailing Address
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Address Line | 877 STEWART AVE SUITE 2
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City | GARDEN CITY
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State | NY
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Zip | 11530-4803
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Country | US
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Telephone | 516-222-1105
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Fax | 516-222-1161
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAJESH S KAKANI
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Credential | MD
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Telephone | 516-222-1105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 208436
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License Number State | NY
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