Provider Demographics
NPI:1720892623
Name:KAILEY, KAMALJIT RAM
Entity type:Individual
Prefix:
First Name:KAMALJIT
Middle Name:RAM
Last Name:KAILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 77TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1525
Mailing Address - Country:US
Mailing Address - Phone:929-271-8129
Mailing Address - Fax:
Practice Address - Street 1:6995 QUEENS MIDTOWN EXPY
Practice Address - Street 2:
Practice Address - City:MASPETH
Practice Address - State:NY
Practice Address - Zip Code:11378-1922
Practice Address - Country:US
Practice Address - Phone:718-429-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP132824208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice