MEDICARE: YASHODHARA KIRTANE

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	207RA0201X	Allergy & Immunology (Internal Medicine) Physician	154995	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2099733	OTHER	NY	GHI
2	271AU2	OTHER	NY	BC/BS

General Provider Information

NPI Number	:	1275588022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YASHODHARA KIRTANE

Provider Business Mailing Address
First Line	:	114-12 BEACH CHANNEL DR
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-1514
Country	:	US
Telephone Number	:	718-318-6021
Fax Number	:	718-318-4802

Provider Business Practice Location Address
First Line	:	114-12 BEACH CHANNEL DR
Second Line	:
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11694-1514
Country	:	US
Telephone Number	:	718-318-6021
Fax Number	:	718-318-4802

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	03/09/2011

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Directions to “ YASHODHARA KIRTANE ” Practice Location

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