Provider Demographics
NPI:1992860290
Name:IYER, KAMLA (MD)
Entity Type:Individual
Prefix:MS
First Name:KAMLA
Middle Name:
Last Name:IYER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KAMLA
Other - Middle Name:C
Other - Last Name:MARIWALLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1405 PEBBLE LANE
Mailing Address - Street 2:
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-1705
Mailing Address - Country:US
Mailing Address - Phone:516-374-1662
Mailing Address - Fax:516-374-7992
Practice Address - Street 1:1405 PEBBLE LANE
Practice Address - Street 2:
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-1705
Practice Address - Country:US
Practice Address - Phone:516-374-1662
Practice Address - Fax:516-374-7992
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118354174400000X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
B79986Medicare UPIN