Basic Information
| Provider Information | |||||||||
| NPI: | 1245753243 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAUR | ||||||||
| FirstName: | AMANDEEP | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 355 BARD AVE | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103101699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188181645 | ||||||||
| FaxNumber: | 7188183225 | ||||||||
| Practice Location | |||||||||
| Address1: | 355 BARD AVE | ||||||||
| Address2: | |||||||||
| City: | STATEN ISLAND | ||||||||
| State: | NY | ||||||||
| PostalCode: | 103101699 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188181645 | ||||||||
| FaxNumber: | 7188183225 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2017 | ||||||||
| LastUpdateDate: | 10/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 30678701 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.