MEDICARE: K ISWARA PC

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	207RG0100X	Gastroenterology Physician	115155	NY

General Provider Information

NPI Number	:	1548421845
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	K ISWARA PC

Provider Business Mailing Address
First Line	:	6010 BAYPARK WAY
Second Line	:	SUITE 801
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2567
Country	:	US
Telephone Number	:	718-615-0400
Fax Number	:	718-615-0874

Provider Business Practice Location Address
First Line	:	6010 BAYPARK WAY
Second Line	:	SUITE 801
City	:	BROOKLYN
State	:	NY
Zip	:	11204-2567
Country	:	US
Telephone Number	:	718-615-0400
Fax Number	:	718-615-0874

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	KADIRAWELPILLAI ISWARA
Credential	:	MD
Telephone Number	:	718-615-0400

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	04/12/2016

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