MEDICARE: KAILASH CHANDRA SAXENA

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	207Y00000X	Otolaryngology Physician	P133543	NY
2	207K00000X	Allergy & Immunology Physician	P133543	NY

General Provider Information

NPI Number	:	1790597052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAILASH CHANDRA SAXENA

Provider Business Mailing Address
First Line	:	216 N 2ND ST
Second Line	:
City	:	BETHPAGE
State	:	NY
Zip	:	11714-2104
Country	:	US
Telephone Number	:	516-503-1179
Fax Number	:

Provider Business Practice Location Address
First Line	:	828 E 149TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10455-4670
Country	:	US
Telephone Number	:	718-583-7736
Fax Number	:	844-457-7750

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

Provider Enumeration Date	:	01/23/2025
Last Update Date	:	01/23/2025

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Directions to “ KAILASH CHANDRA SAXENA ” Practice Location

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