MEDICARE: JERICHO NEPHROLOGY PLLC

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	207RN0300X	Nephrology Physician

General Provider Information

NPI Number	:	1215869276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JERICHO NEPHROLOGY PLLC

Provider Business Mailing Address
First Line	:	14 TIOGA DR
Second Line	:
City	:	JERICHO
State	:	NY
Zip	:	11753-1930
Country	:	US
Telephone Number	:	917-302-3909
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 TIOGA DR
Second Line	:
City	:	JERICHO
State	:	NY
Zip	:	11753-1930
Country	:	US
Telephone Number	:	917-302-3909
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MANDEEP KAUR
Credential	:	MD
Telephone Number	:	917-302-3909

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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