Basic Information
| Provider Information | |||||||||
| NPI: | 1487641601 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LATHI | ||||||||
| FirstName: | KISHOR | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45 SECOR RD | ||||||||
| Address2: | |||||||||
| City: | SCARSDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 105837224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9147134130 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1055 WASHINGTON BLVD | ||||||||
| Address2: | SUITE 440 | ||||||||
| City: | STAMFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 069012216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2033482614 | ||||||||
| FaxNumber: | 2033258677 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2005 | ||||||||
| LastUpdateDate: | 07/30/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 044999 | CT | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0190586 | 05 | MA | MEDICAID |