Provider Demographics
NPI:1114280013
Name:DAS, RENUKA
Entity Type:Individual
Prefix:MRS
First Name:RENUKA
Middle Name:
Last Name:DAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 RADCLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10462-3404
Mailing Address - Country:US
Mailing Address - Phone:347-244-6674
Mailing Address - Fax:718-823-9765
Practice Address - Street 1:1950 RADCLIFF AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-3404
Practice Address - Country:US
Practice Address - Phone:347-244-6674
Practice Address - Fax:718-823-9765
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-17
Last Update Date:2012-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist