1912956889 NPI number — JANAKI KANUMILLI MD

Table of content: JANAKI KANUMILLI MD (NPI 1912956889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912956889 NPI number — JANAKI KANUMILLI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KANUMILLI
Provider First Name:
JANAKI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1912956889
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11050 71ST RD
Provider Second Line Business Mailing Address:
SUITE 1B
Provider Business Mailing Address City Name:
FOREST HILLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11375-4969
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-263-5909
Provider Business Mailing Address Fax Number:
718-343-3979

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8338 LITTLE NECK PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORAL PARK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11004-1626
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-347-0504
Provider Business Practice Location Address Fax Number:
718-343-3979
Provider Enumeration Date:
05/09/2006

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: 207QA0505X , with the licence number:  222149 , 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: 02362729 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201993043 . This is a "1199" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 3001048 . This is a "AETNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5997928 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 084821488 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 4C6090 . This is a "ACS HEALTH NET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P2718132 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 191803007 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 5485D . This is a "EMPIRE BLUE CROSS BLUE SH" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 141539 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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