Provider Demographics
NPI:1104900778
Name:AMESUR, KIRAN BHAGWAN (MD)
Entity type:Individual
Prefix:DR
First Name:KIRAN
Middle Name:BHAGWAN
Last Name:AMESUR
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 1:947 LINWOOD AVE
Mailing Address - Street 2:SUITE 2 SOUTH
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-2939
Mailing Address - Country:US
Mailing Address - Phone:201-857-4751
Mailing Address - Fax:201-857-4752
Practice Address - Street 1:947 LINWOOD AVE
Practice Address - Street 2:SUITE 2 SOUTH
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-2939
Practice Address - Country:US
Practice Address - Phone:201-857-4751
Practice Address - Fax:201-857-4752
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 07468300207W00000X
NY213110207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
065952Medicare ID - Type Unspecified
H19001Medicare UPIN