Provider Demographics
NPI:1356455984
Name:KUMAR, GEETHA (MD,)
Entity Type:Individual
Prefix:
First Name:GEETHA
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 JODY CT
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1921
Mailing Address - Country:US
Mailing Address - Phone:516-679-8628
Mailing Address - Fax:718-531-6916
Practice Address - Street 1:1695 REMSEN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-5233
Practice Address - Country:US
Practice Address - Phone:718-531-6911
Practice Address - Fax:718-531-6916
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY146832207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00836071Medicaid
NY00836071Medicaid
NY21D871Medicare ID - Type Unspecified