Provider Demographics
NPI:1356531883
Name:MAMIK, MAMTA M (MD)
Entity type:Individual
Prefix:DR
First Name:MAMTA
Middle Name:M
Last Name:MAMIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MAMTA
Other - Middle Name:M
Other - Last Name:KULKARNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1400 PELHAM PKWY S
Mailing Address - Street 2:BLDG 1, ROOM BS27
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1119
Mailing Address - Country:US
Mailing Address - Phone:914-721-3359
Mailing Address - Fax:
Practice Address - Street 1:1400 PELHAM PKWY S
Practice Address - Street 2:BLDG 1, ROOM BS27
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1119
Practice Address - Country:US
Practice Address - Phone:914-721-3359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-31
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301085885207V00000X
NY267923207VF0040X
NMMD2009-0223207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyUrogynecology and Reconstructive Pelvic Surgery