Provider Demographics
NPI:1861577298
Name:KATHPALIA, KUSUM (MD)
Entity type:Individual
Prefix:DR
First Name:KUSUM
Middle Name:
Last Name:KATHPALIA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 BRISTOL DR
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3944
Mailing Address - Country:US
Mailing Address - Phone:516-708-7700
Mailing Address - Fax:718-264-4168
Practice Address - Street 1:460 W 34TH ST
Practice Address - Street 2:9TH FL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-2320
Practice Address - Country:US
Practice Address - Phone:212-273-6519
Practice Address - Fax:212-868-0963
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1462622084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00708609Medicaid
NY091K51Medicare ID - Type Unspecified
NY00708609Medicaid