1265730907 NPI number — NARINDER KUKAR PHYSICIAN P C

Table of content: (NPI 1265730907)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265730907 NPI number — NARINDER KUKAR PHYSICIAN P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NARINDER KUKAR PHYSICIAN P C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1265730907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
385 SENECA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIDGEWOOD
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11385-1340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-497-0060
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
385 SENECA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGEWOOD
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11385-1340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-497-0060
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KUKAR
Authorized Official First Name:
NARINDER
Authorized Official Middle Name:
MOHAN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
718-497-0060

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  111361 , 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: B14807 . This is a "UPIN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: A100047019 . This is a "MEDICARE PTAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 24594P . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00200115 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: KS918 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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