Provider Demographics
NPI:1205821147
Name:DAS, KAUSHIK (MD)
Entity Type:Individual
Prefix:
First Name:KAUSHIK
Middle Name:
Last Name:DAS
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 1:4 WESTCHESTER PARK DR STE 320
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-3497
Mailing Address - Country:US
Mailing Address - Phone:914-948-8003
Mailing Address - Fax:914-686-5478
Practice Address - Street 1:4 WESTCHESTER PARK DR FL 4
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10604-3434
Practice Address - Country:US
Practice Address - Phone:914-948-8448
Practice Address - Fax:914-345-3182
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201485-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02129835Medicaid
NY09R76X0531Medicare PIN
NY02129835Medicaid