Basic Information
| Provider Information | |||||||||
| NPI: | 1023008984 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KANNAN | ||||||||
| FirstName: | ARUL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 95 GENESEE ST | ||||||||
| Address2: | |||||||||
| City: | NEW HARTFORD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134132357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157247366 | ||||||||
| FaxNumber: | 3157240293 | ||||||||
| Practice Location | |||||||||
| Address1: | 95 GENESEE ST | ||||||||
| Address2: | |||||||||
| City: | NEW HARTFORD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134132357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157247366 | ||||||||
| FaxNumber: | 3157240293 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2005 | ||||||||
| LastUpdateDate: | 12/03/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 211037-1 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01900747 | 05 | NY | MEDICAID |