Provider Demographics
NPI:1376501023
Name:JAVALY, KEDARNATH (MD)
Entity Type:Individual
Prefix:DR
First Name:KEDARNATH
Middle Name:
Last Name:JAVALY
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 1:31 BEECH RD
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-2330
Mailing Address - Country:US
Mailing Address - Phone:917-612-6413
Mailing Address - Fax:
Practice Address - Street 1:2914 ELMWOOD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:KENMORE
Practice Address - State:NY
Practice Address - Zip Code:14217-1332
Practice Address - Country:US
Practice Address - Phone:716-447-6903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164017-1207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00442452OtherRAILROAD MEDICARE
NY01844866Medicaid
NY01844866Medicaid
NYRB6318Medicare PIN