Provider Demographics
NPI:1013930049
Name:KAPILA, BARDEV (MD)
Entity Type:Individual
Prefix:DR
First Name:BARDEV
Middle Name:
Last Name:KAPILA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 HURLEY AVE STE 15
Mailing Address - Street 2:PO BOX 3600
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12402
Mailing Address - Country:US
Mailing Address - Phone:845-338-1825
Mailing Address - Fax:845-338-5114
Practice Address - Street 1:40 HURLEY AVE
Practice Address - Street 2:STE 15
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401
Practice Address - Country:US
Practice Address - Phone:845-338-1825
Practice Address - Fax:845-338-5114
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1074831207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY047001OtherMVP
NY00554687Medicaid
NY528065OtherAETNA
NY047001OtherMVP
C11601Medicare UPIN