MEDICARE: DR. RAKESH KUMAR DUA MD

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	208000000X	Pediatrics Physician	208733	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063478204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RAKESH KUMAR DUA MD

Provider Business Mailing Address
First Line	:	23 BRIDLE PATH
Second Line	:
City	:	ROSLYN
State	:	NY
Zip	:	11576-3115
Country	:	US
Telephone Number	:	718-968-2534
Fax Number	:	718-968-0573

Provider Business Practice Location Address
First Line	:	2035 RALPH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-5300
Country	:	US
Telephone Number	:	718-968-2534
Fax Number	:	718-968-0573

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

Provider Enumeration Date	:	04/25/2006
Last Update Date	:	07/08/2007

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