Provider Demographics
NPI:1508880279
Name:KUMARI, JAISHREE (MD)
Entity Type:Individual
Prefix:
First Name:JAISHREE
Middle Name:
Last Name:KUMARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10552
Mailing Address - Country:US
Mailing Address - Phone:914-309-3239
Mailing Address - Fax:718-960-1501
Practice Address - Street 1:2532 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-4902
Practice Address - Country:US
Practice Address - Phone:718-960-1500
Practice Address - Fax:718-960-1501
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255569207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02858340Medicaid