1730121575 NPI number — SANJOY BANERJEE MD

Table of content: SANJOY BANERJEE MD (NPI 1730121575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730121575 NPI number — SANJOY BANERJEE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANERJEE
Provider First Name:
SANJOY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1730121575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2109 HUGHES DR
Provider Second Line Business Mailing Address:
SUITE 860
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43606-3856
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-291-7010
Provider Business Mailing Address Fax Number:
419-479-6917

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2109 HUGHES DR
Provider Second Line Business Practice Location Address:
SUITE 860
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43606-3856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-291-7010
Provider Business Practice Location Address Fax Number:
419-479-6917
Provider Enumeration Date:
06/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2080P0206X , with the licence number:  35.087838 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000521494 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 5202134 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7978181 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 06120 . This is a "PARAMOUNT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2665692 . This is a "BCMH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: $$$$$$$$$ . This is a "MMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2665692 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 734534 . This is a "BUCKEYE COMMUNITY HEALTH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 46880 . This is a "HEALTH PLAN OF MI" identifier . This identifiers is of the category "OTHER".




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