Provider Demographics
NPI:1326784216
Name:KAUR, MANDEEP
Entity Type:Individual
Prefix:
First Name:MANDEEP
Middle Name:
Last Name:KAUR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 STOCKHOLM STREET
Mailing Address - Street 2:ROOM C-408
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237
Mailing Address - Country:US
Mailing Address - Phone:646-220-0692
Mailing Address - Fax:
Practice Address - Street 1:374 STOCKHOLM STREET
Practice Address - Street 2:ROOM C-408
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237
Practice Address - Country:US
Practice Address - Phone:646-220-0692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2023-04-26
Deactivation Date:2023-01-04
Deactivation Code:
Reactivation Date:2023-04-26
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program