Provider Demographics
NPI:1386897247
Name:KRG MEDICAL PC
Entity type:Organization
Organization Name:KRG MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PANHANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-464-6322
Mailing Address - Street 1:21533 JAMAICA AVE
Mailing Address - Street 2:QUEENS VILLAGE
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11428-1736
Mailing Address - Country:US
Mailing Address - Phone:718-464-6322
Mailing Address - Fax:718-464-6141
Practice Address - Street 1:21533 JAMAICA AVE
Practice Address - Street 2:QUEENS VILLAGE
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1736
Practice Address - Country:US
Practice Address - Phone:718-464-6322
Practice Address - Fax:718-464-6141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1993981261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY18U831OtherMEDICARE
NY01583586Medicaid
NY01583586Medicaid