Provider Demographics
NPI:1720856719
Name:MISRILALL, KAVI
Entity Type:Individual
Prefix:
First Name:KAVI
Middle Name:
Last Name:MISRILALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 CHERRYWOOD RD
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10710-1101
Mailing Address - Country:US
Mailing Address - Phone:202-681-8433
Mailing Address - Fax:866-302-7508
Practice Address - Street 1:67 CHERRYWOOD RD
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10710-1101
Practice Address - Country:US
Practice Address - Phone:202-681-8433
Practice Address - Fax:866-302-7508
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor