Provider Demographics
NPI:1124366372
Name:NANDI, DIPAK
Entity Type:Individual
Prefix:
First Name:DIPAK
Middle Name:
Last Name:NANDI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4142 ELBERTSON ST
Mailing Address - Street 2:102
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1620
Mailing Address - Country:US
Mailing Address - Phone:718-505-1300
Mailing Address - Fax:718-505-1883
Practice Address - Street 1:4142 ELBERTSON ST
Practice Address - Street 2:102
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1620
Practice Address - Country:US
Practice Address - Phone:718-505-1300
Practice Address - Fax:718-505-1883
Is Sole Proprietor?:No
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA1619262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA161926OtherLICENSE NUMBER