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General NPI Number Information
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NPI Number | 1790219335
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Entity Type | Individual
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Provider Name | ABDULJALEEL POOVATHUMKADAVIL M.D
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Gender | Male
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Dates
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Enumeration Date | 04/19/2017
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Last Update Date | 04/19/2017
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Provider Practice Location Address
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Address Line | 90 AUTUMN CREEK LN APT. F
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City | EAST AMHERST
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State | NY
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Zip | 14051-2918
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Country | US
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Telephone | 716-800-9089
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Fax |
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Provider Business Mailing Address
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Address Line | 90 AUTUMN CREEK LN APT. F
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City | EAST AMHERST
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State | NY
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Zip | 14051-2918
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Country | US
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Telephone | 716-800-9089
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | AMO395168
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License Number State | TN
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