Provider Demographics
NPI:1700013174
Name:KHETERPAL, MEENAL KAPOOR (MD)
Entity Type:Individual
Prefix:
First Name:MEENAL
Middle Name:KAPOOR
Last Name:KHETERPAL
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 1:500 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10604-3200
Mailing Address - Country:US
Mailing Address - Phone:914-367-7295
Mailing Address - Fax:646-227-7274
Practice Address - Street 1:500 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:WEST HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10604-3200
Practice Address - Country:US
Practice Address - Phone:914-367-7295
Practice Address - Fax:646-227-7274
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY271678207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03649369Medicaid
NY03649369Medicaid