Provider Demographics
NPI:1063557726
Name:KANTU, KANHAIYALAL (MD)
Entity type:Individual
Prefix:DR
First Name:KANHAIYALAL
Middle Name:
Last Name:KANTU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 VOORHIES AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-2820
Mailing Address - Country:US
Mailing Address - Phone:718-646-2500
Mailing Address - Fax:718-648-4583
Practice Address - Street 1:2204 VOORHIES AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-2820
Practice Address - Country:US
Practice Address - Phone:718-646-2500
Practice Address - Fax:718-648-4583
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109919174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000053548OtherGHIHMO
NY00195506Medicaid
NY3877816OtherAETNAHMO
NYKS022OtherOXFORD
NY000423053OtherUHC
NY069186610OtherBCBS
NYMCA151503OtherAMERICHOICEBR
NYNPC24405OtherELDERPLAN
NY113515454Other1199
NYMCA151503OtherAMERICHOICESSB
NY0699692OtherGHIPPO
NY109919OtherHIPID
NY208745A40OtherHEALTHFIRST
NY7058737OtherAETNAPPO
NY14657OtherUSHC
NY24505POtherHIPPRISS
NY37887540002OtherCIGNA
NY3C6891OtherHEALTHNET
NY208745A40OtherHEALTHFIRST
NY691861Medicare ID - Type Unspecified