Provider Demographics
NPI:1194710574
Name:KAICKER, SHIPRA (MD)
Entity type:Individual
Prefix:
First Name:SHIPRA
Middle Name:
Last Name:KAICKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHIPRA
Other - Middle Name:
Other - Last Name:MEHROTRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:977 48TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-2919
Mailing Address - Country:US
Mailing Address - Phone:718-283-8015
Mailing Address - Fax:718-635-7235
Practice Address - Street 1:948 48TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-2918
Practice Address - Country:US
Practice Address - Phone:718-283-8260
Practice Address - Fax:718-635-7235
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2245722080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY224572OtherHIP
NY2316540OtherUNITED HEALTH CARE
NY224572-A15OtherHEALTH FIRST
NY2696715OtherGHI
NYP2904832OtherOXFORD HEALTH PLAN
NY1000036671OtherAFFINITY HEALTH
NY02406077Medicaid
NY8E3331OtherEMPIRE BCBS
NYKS4572OtherATLANTIS HEALTH
NY3C3478OtherHEALTH NET
NYKS4572OtherATLANTIS HEALTH
NYI00996Medicare UPIN