Provider Demographics
NPI:1912956889
Name:KANUMILLI, JANAKI (MD)
Entity Type:Individual
Prefix:
First Name:JANAKI
Middle Name:
Last Name:KANUMILLI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11050 71ST RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4969
Mailing Address - Country:US
Mailing Address - Phone:718-263-5909
Mailing Address - Fax:718-343-3979
Practice Address - Street 1:8338 LITTLE NECK PKWY
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11004-1626
Practice Address - Country:US
Practice Address - Phone:718-347-0504
Practice Address - Fax:718-343-3979
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222149207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02362729Medicaid
NY201993043Other1199
NY3001048OtherAETNA
NY5997928OtherGHI
NY084821488OtherUNITED HEALTH CARE
NY4C6090OtherACS HEALTH NET
NYP2718132OtherOXFORD
NY191803007OtherCIGNA
NY5485DOtherEMPIRE BLUE CROSS BLUE SH
NY141539OtherHIP