Provider Demographics
NPI:1124161799
Name:KOUL, RAKESH KUMAR (MD)
Entity type:Individual
Prefix:
First Name:RAKESH
Middle Name:KUMAR
Last Name:KOUL
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 1:63 WILSON AVE
Mailing Address - Street 2:WESTBURY
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-2114
Mailing Address - Country:US
Mailing Address - Phone:516-503-7032
Mailing Address - Fax:
Practice Address - Street 1:900 HILLSIDE AVE
Practice Address - Street 2:NEW HYDE PARK
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:516-519-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY253373207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program