Provider Demographics
NPI:1205631686
Name:KOLANUKUDURU, KAUSHIK PRABHAV
Entity type:Individual
Prefix:DR
First Name:KAUSHIK
Middle Name:PRABHAV
Last Name:KOLANUKUDURU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 E 96TH ST APT 3RE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3834
Mailing Address - Country:US
Mailing Address - Phone:646-400-4614
Mailing Address - Fax:
Practice Address - Street 1:525 EAST 68TH STREET
Practice Address - Street 2:STARR 9
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065
Practice Address - Country:US
Practice Address - Phone:646-400-4614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program