Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | 290612 | NY |
Y | 2081S0010X | Sports Medicine | 290612 | NY |
Y | 213ES0000X | Sports Medicine | 290612 | NY |
NPI | 1154689008 |
---|---|
Provider Name | Bittu Kuruvilla |
First Address | Norfolk, VA 23507-2007 |
Second Address | Bronx, NY 10467-2412 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2012 |
Last Update Date | 31/07/2017 |