Provider Demographics
NPI:1770233157
Name:MAHAL, KULDEEP
Entity type:Individual
Prefix:
First Name:KULDEEP
Middle Name:
Last Name:MAHAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SQUIRETOWN RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2011
Mailing Address - Country:US
Mailing Address - Phone:631-728-5300
Mailing Address - Fax:
Practice Address - Street 1:5 SQUIRETOWN RD
Practice Address - Street 2:
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2011
Practice Address - Country:US
Practice Address - Phone:631-728-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2025-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1770233157208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics