MEDICARE: SHEELA MANOJ KURUP M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	232733	NY

General Provider Information

NPI Number	:	1013917863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEELA MANOJ KURUP M.D.

Provider Business Mailing Address
First Line	:	24 ROY ST
Second Line	:
City	:	ELMONT
State	:	NY
Zip	:	11003-4341
Country	:	US
Telephone Number	:	516-437-5423
Fax Number	:	516-437-5423

Provider Business Practice Location Address
First Line	:	BERNARD FINESON DEVELOPMENTAL CENTER
Second Line	:	HILLSIDE COMPLEX
City	:	QUEENS VILLAGE
State	:	NY
Zip	:	11428-0507
Country	:	US
Telephone Number	:	718-217-4242
Fax Number	:	718-217-6068

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2005
Last Update Date	:	07/08/2007

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