Provider Demographics
NPI:1023008984
Name:KANNAN, ARUL (MD)
Entity Type:Individual
Prefix:
First Name:ARUL
Middle Name:
Last Name:KANNAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2357
Mailing Address - Country:US
Mailing Address - Phone:315-724-7366
Mailing Address - Fax:315-724-0293
Practice Address - Street 1:95 GENESEE ST
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-2357
Practice Address - Country:US
Practice Address - Phone:315-724-7366
Practice Address - Fax:315-724-0293
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211037-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01900747Medicaid
NY01900747Medicaid
NYIA1389Medicare PIN
NYBB7890Medicare PIN
NYG87632Medicare UPIN