MEDICARE: KINJEL GATHA D.D.S

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	122300000X	Dentist	50 055133	NY

General Provider Information

NPI Number	:	1316179922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KINJEL GATHA D.D.S

Provider Business Mailing Address
First Line	:	26910 GRAND CENTRAL PKWY
Second Line	:	BUILDING 3, APARTMENT 3S
City	:	FLORAL PARK
State	:	NY
Zip	:	11005-1045
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	26910 GRAND CENTRAL PKWY
Second Line	:	BUILDING 3, APARTMENT 3S
City	:	FLORAL PARK
State	:	NY
Zip	:	11005-1045
Country	:	US
Telephone Number	:	516-562-4525
Fax Number	:

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

Provider Enumeration Date	:	08/14/2009
Last Update Date	:	12/19/2013

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