1013959386 NPI number — PUJAN GASTROENTEROLOGIST, PLLC

Table of content: (NPI 1013959386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013959386 NPI number — PUJAN GASTROENTEROLOGIST, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PUJAN GASTROENTEROLOGIST, PLLC
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:
1013959386
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
161 TRUMAN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRESSKILL
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07626-1709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-568-1243
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1650 GRAND CONCOURSE
Provider Second Line Business Practice Location Address:
DIVISION OF GASTROENTEROLOGY, 3RD FLOOR
Provider Business Practice Location Address City Name:
BRONX
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10457-7606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-518-5550
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BALAR
Authorized Official First Name:
BHAVNA
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
201-568-1243

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  219532 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02459781 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".