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Organization

KSP HEALTH - NY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. MUTHUKUMAR VELLAICHAMY MD (OWNER)
(234) 260-6212
Entity
Organization

Contact information

Practice address
418 BROADWAY STE R, ALBANY, NY 12207-2922
(234) 260-6212
Mailing address
6446 E CENTRAL AVE STE 183, WICHITA, KS 67206-1923
(234) 260-6212

Taxonomy

Speciality
Code
Description
License number
State
163WP0200X
Pediatric Registered Nurse
207NP0225X
Pediatric Dermatology Physician
208000000X
Pediatrics Physician
Primary
2080A0000X
Pediatric Adolescent Medicine Physician
2080P0006X
Developmental - Behavioral Pediatrics Physician
2080P0202X
Pediatric Cardiology Physician
2080P0203X
Pediatric Critical Care Medicine Physician

Other

Enumeration date
01/03/2024
Last updated
01/03/2024
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