Provider Demographics
NPI:1255627725
Name:JANAKI KANUMILLI, MD P.C.
Entity type:Organization
Organization Name:JANAKI KANUMILLI, MD P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANAKI
Authorized Official - Middle Name:
Authorized Official - Last Name:KANUMILLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-268-1458
Mailing Address - Street 1:11050 71ST RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4969
Mailing Address - Country:US
Mailing Address - Phone:718-268-1458
Mailing Address - Fax:718-897-1926
Practice Address - Street 1:11050 71ST RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4969
Practice Address - Country:US
Practice Address - Phone:718-268-1458
Practice Address - Fax:718-897-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-23
Last Update Date:2011-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222149302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02362729Medicaid
NYP00902325OtherRAILROAD MEDICARE
NYP00902325OtherRAILROAD MEDICARE