1063557726 NPI number — DR. KANHAIYALAL KANTU M.D.

Table of content: DR. KANHAIYALAL KANTU M.D. (NPI 1063557726)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063557726 NPI number — DR. KANHAIYALAL KANTU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KANTU
Provider First Name:
KANHAIYALAL
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063557726
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2204 VOORHIES AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11235-2820
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-646-2500
Provider Business Mailing Address Fax Number:
718-648-4583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2204 VOORHIES AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11235-2820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-646-2500
Provider Business Practice Location Address Fax Number:
718-648-4583
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  109919 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000053548 . This is a "GHIHMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00195506 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3877816 . This is a "AETNAHMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: KS022 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 000423053 . This is a "UHC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 069186610 . This is a "BCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: MCA151503 . This is a "AMERICHOICEBR" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: NPC24405 . This is a "ELDERPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 113515454 . This is a "1199" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: MCA151503 . This is a "AMERICHOICESSB" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0699692 . This is a "GHIPPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 109919 . This is a "HIPID" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 208745A40 . This is a "HEALTHFIRST" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7058737 . This is a "AETNAPPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 14657 . This is a "USHC" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 24505P . This is a "HIPPRISS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 37887540002 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3C6891 . This is a "HEALTHNET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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