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General NPI Number Information
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NPI Number | 1902399181
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Entity Type | Organization
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Legal Business Name | NORTHEAST RHEUMATOLOGY INITIATIVE PLLC
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Dates
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Enumeration Date | 06/12/2018
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Last Update Date | 06/12/2018
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Provider Practice Location Address
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Address Line | 2500 POND VW STE 202
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City | CASTLETON
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State | NY
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Zip | 12033-9776
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Country | US
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Telephone | 701-202-7217
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Fax |
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Provider Business Mailing Address
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Address Line | 9 SHELBOURNE DR
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City | LOUDONVILLE
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State | NY
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Zip | 12211-2608
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Country | US
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Telephone | 701-202-7217
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PRASHANT KAUSHIK
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Credential | MD
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Telephone | 701-202-7217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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