Basic Information
| Provider Information | |||||||||
| NPI: | 1942649843 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAKKAR | ||||||||
| FirstName: | PRIYA | ||||||||
| MiddleName: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 70 E SUNRISE HWY | ||||||||
| Address2: | SUITE 515 | ||||||||
| City: | VALLEY STREAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115811240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165365656 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 70 E SUNRISE HWY | ||||||||
| Address2: | SUITE 515 | ||||||||
| City: | VALLEY STREAM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115811240 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5165365656 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/24/2013 | ||||||||
| LastUpdateDate: | 03/31/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 283129-1 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.