Provider Demographics
NPI:1861831364
Name:KALIKA P SRIVASTAVA MD PC
Entity Type:Organization
Organization Name:KALIKA P SRIVASTAVA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KALIKA
Authorized Official - Middle Name:P
Authorized Official - Last Name:SRIVASTAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:518-272-8181
Mailing Address - Street 1:1444 MASSACHUSETTS AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-1600
Mailing Address - Country:US
Mailing Address - Phone:518-272-8181
Mailing Address - Fax:
Practice Address - Street 1:1444 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-1600
Practice Address - Country:US
Practice Address - Phone:518-272-8181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109015207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGMedicaid
NY32067BMedicare PIN