Provider Demographics
NPI:1902399181
Name:NORTHEAST RHEUMATOLOGY INITIATIVE PLLC
Entity Type:Organization
Organization Name:NORTHEAST RHEUMATOLOGY INITIATIVE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRASHANT
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUSHIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-202-7217
Mailing Address - Street 1:9 SHELBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12211-2608
Mailing Address - Country:US
Mailing Address - Phone:701-202-7217
Mailing Address - Fax:
Practice Address - Street 1:2500 POND VW STE 202
Practice Address - Street 2:
Practice Address - City:CASTLETON
Practice Address - State:NY
Practice Address - Zip Code:12033-9776
Practice Address - Country:US
Practice Address - Phone:701-202-7217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGMedicaid