Provider Demographics
NPI:1598703134
Name:KUNNIRICKAL, VARSHA V (MD)
Entity Type:Individual
Prefix:DR
First Name:VARSHA
Middle Name:V
Last Name:KUNNIRICKAL
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 1:188 E 64TH ST APT 1001
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-7463
Mailing Address - Country:US
Mailing Address - Phone:240-475-6817
Mailing Address - Fax:
Practice Address - Street 1:515 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-3037
Practice Address - Country:US
Practice Address - Phone:240-475-6817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-04
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD506462084P0800X
NY301708-012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD363400100Medicaid
MDG30110Medicare UPIN
MD363400100Medicaid