Basic Information
| Provider Information | |||||||||
| NPI: | 1609154186 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUA | ||||||||
| FirstName: | DIVYA | ||||||||
| MiddleName: | KAUSHIK | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 129 W 29TH ST # W | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100015105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4156586791 | ||||||||
| FaxNumber: | 4155200904 | ||||||||
| Practice Location | |||||||||
| Address1: | 28 STATE ST | ||||||||
| Address2: | SUITE 2860 | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021091775 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6179035000 | ||||||||
| FaxNumber: | 6179035009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/01/2011 | ||||||||
| LastUpdateDate: | 12/11/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 269435-1 | NY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 261317 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.