Provider Demographics
NPI:1790597052
Name:SAXENA, KAILASH CHANDRA
Entity type:Individual
Prefix:
First Name:KAILASH
Middle Name:CHANDRA
Last Name:SAXENA
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 1:216 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-2104
Mailing Address - Country:US
Mailing Address - Phone:516-503-1179
Mailing Address - Fax:
Practice Address - Street 1:828 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-4670
Practice Address - Country:US
Practice Address - Phone:718-583-7736
Practice Address - Fax:844-457-7750
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP133543207Y00000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology