Provider Demographics
NPI:1003902073
Name:ANANDA, ANUPAMA (MD)
Entity Type:Individual
Prefix:DR
First Name:ANUPAMA
Middle Name:
Last Name:ANANDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANUPAMA
Other - Middle Name:
Other - Last Name:GANESAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:190 WILLIS AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2649
Mailing Address - Country:US
Mailing Address - Phone:516-739-7290
Mailing Address - Fax:516-793-7291
Practice Address - Street 1:190 WILLIS AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-2649
Practice Address - Country:US
Practice Address - Phone:516-739-7290
Practice Address - Fax:516-793-7291
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204248207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG62055Medicare UPIN
NY29N901Medicare ID - Type Unspecified