1851403646 NPI number — INTERNAL MEDICINE CLINIC BANERJI LTD

Table of content: (NPI 1851403646)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851403646 NPI number — INTERNAL MEDICINE CLINIC BANERJI LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERNAL MEDICINE CLINIC BANERJI LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851403646
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/03/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5731 SOUTH FORT APACHE ROAD
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-740-5311
Provider Business Mailing Address Fax Number:
702-740-5310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5731 S FORT APACHE RD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89148-5620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-740-5311
Provider Business Practice Location Address Fax Number:
702-740-5310
Provider Enumeration Date:
08/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BANERJI
Authorized Official First Name:
BASHAB
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
702-740-5311

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  9544 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DD5081 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".