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General NPI Number Information
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NPI Number | 1205631686
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Entity Type | Individual
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Provider Name | DR. KAUSHIK PRABHAV KOLANUKUDURU
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Gender | Male
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Dates
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Enumeration Date | 02/18/2025
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Last Update Date | 02/18/2025
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Provider Practice Location Address
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Address Line | 525 EAST 68TH STREET STARR 9
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City | NEW YORK
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State | NY
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Zip | 10065
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Country | US
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Telephone | 646-400-4614
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Fax |
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Provider Business Mailing Address
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Address Line | 229 E 96TH ST APT 3RE
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City | NEW YORK
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State | NY
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Zip | 10128-3834
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Country | US
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Telephone | 646-400-4614
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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