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General NPI Number Information
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NPI Number | 1255627725
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Entity Type | Organization
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Legal Business Name | JANAKI KANUMILLI, MD P.C.
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Dates
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Enumeration Date | 06/23/2011
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Last Update Date | 06/23/2011
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Provider Practice Location Address
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Address Line | 11050 71ST RD SUITE 1B
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City | FOREST HILLS
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State | NY
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Zip | 11375-4969
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Country | US
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Telephone | 718-268-1458
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Fax | 718-897-1926
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Provider Business Mailing Address
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Address Line | 11050 71ST RD SUITE 1B
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City | FOREST HILLS
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State | NY
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Zip | 11375-4969
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Country | US
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Telephone | 718-268-1458
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Fax | 718-897-1926
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. JANAKI KANUMILLI
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Credential | MD
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Telephone | 718-268-1458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 222149
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License Number State | NY
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