Provider Demographics
NPI:1114171683
Name:GURUNG, RADHA
Entity type:Individual
Prefix:
First Name:RADHA
Middle Name:
Last Name:GURUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40-37 77TH STREET
Mailing Address - Street 2:APT 4J
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373
Mailing Address - Country:US
Mailing Address - Phone:347-513-2545
Mailing Address - Fax:
Practice Address - Street 1:4037 77TH ST
Practice Address - Street 2:APT 4J
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1156
Practice Address - Country:US
Practice Address - Phone:347-513-2545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY276052164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse