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General NPI Number Information
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NPI Number | 1619275906
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Entity Type | Organization
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Legal Business Name | NEW YORK EAR NOSE AND THROAT SPECIALIST PC
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Dates
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Enumeration Date | 03/10/2011
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Last Update Date | 04/04/2011
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Provider Practice Location Address
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Address Line | 3 KETTLEPOND RD
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City | JERICHO
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State | NY
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Zip | 11753-1157
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Country | US
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Telephone | 516-222-2524
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Fax |
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Provider Business Mailing Address
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Address Line | 3 KETTLEPOND RD
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City | JERICHO
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State | NY
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Zip | 11753-1157
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Country | US
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Telephone | 516-222-2524
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Fax |
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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 | M.D.
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Telephone | 516-222-2524
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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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