MEDICARE: YASHODHARA KIRTANE M.D.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	207RA0201X	Allergy & Immunology (Internal Medicine) Physician

General Provider Information

NPI Number	:	1417902248
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YASHODHARA KIRTANE M.D.PLLC

Provider Business Mailing Address
First Line	:	114-12 BEACH CHANNEL DR
Second Line	:	SUITE #7
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11559-1514
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	:	SUITE #7
City	:	ROCKAWAY PARK
State	:	NY
Zip	:	11559-1514
Country	:	US
Telephone Number	:	718-318-6021
Fax Number	:	718-318-4802

Authorized Official
Title or Position	:	OWNER
Name	:	YASHODHARA KIRTANE
Credential	:
Telephone Number	:	718-318-6021

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	09/15/2010

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