Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0201X | Internist - Allergy & Immunology | 188703 | NY |
NPI | 1093745556 |
---|---|
Provider Name | Nanjundaiah Kumar |
First Address | Syosset, NY 11791-5401 |
Second Address | Jackson Heights, NY 11372 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2006 |
Last Update Date | 16/02/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G30473 | (02) |