Provider Demographics
NPI:1053560649
Name:KAMBILI, CHRISPIN (MD)
Entity type:Individual
Prefix:
First Name:CHRISPIN
Middle Name:
Last Name:KAMBILI
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 1:42-09 28TH STREET
Mailing Address - Street 2:CN-48
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-4132
Mailing Address - Country:US
Mailing Address - Phone:347-396-6299
Mailing Address - Fax:347-396-6367
Practice Address - Street 1:34-33 JUNCTION BLVD
Practice Address - Street 2:CORONA CHEST CENTER FL2
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-3828
Practice Address - Country:US
Practice Address - Phone:718-396-5134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-18
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2060061207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH89729Medicare UPIN