1386874329 NPI number — NEERAJ ANAND MD

Table of content: NEERAJ ANAND MD (NPI 1386874329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386874329 NPI number — NEERAJ ANAND MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANAND
Provider First Name:
NEERAJ
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:
1386874329
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39 BRENTWOOD ROAD
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
BAYSHORE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-968-8288
Provider Business Mailing Address Fax Number:
631-968-8268

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
39 BRENTWOOD ROAD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
BAYSHORE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-968-8288
Provider Business Practice Location Address Fax Number:
631-968-8268
Provider Enumeration Date:
07/24/2009

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: 207R00000X , with the licence number:  254090 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RG0100X , with the licence number: 052105 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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