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General NPI Number Information
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NPI Number | 1558591040
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Entity Type | Organization
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Legal Business Name | BREAST CARE SPECIALIST, PLLC
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Dates
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Enumeration Date | 07/20/2009
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Last Update Date | 07/20/2009
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Provider Practice Location Address
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Address Line | 117 MARYS AVENUE SUITE 105
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City | KINGSTON
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State | NY
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Zip | 12401
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Country | US
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Telephone | 845-338-8680
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Fax | 845-338-8693
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Provider Business Mailing Address
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Address Line | 117 MARYS AVENUE SUITE 105
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City | KINGSTON
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State | NY
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Zip | 12401
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Country | US
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Telephone | 845-338-8680
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Fax | 845-338-8693
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Authorized Official
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Title or Position | OWNER
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Name | DR. SAMIRA Y KHERA
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Credential | MD MS
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Telephone | 845-338-8680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number |
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License Number State |
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