Provider Demographics
NPI:1164470217
Name:MITTAL, SANDEEP KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:KUMAR
Last Name:MITTAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 EUREKA RD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3027
Mailing Address - Country:US
Mailing Address - Phone:916-784-4000
Mailing Address - Fax:877-738-4262
Practice Address - Street 1:1 COLUMBIA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3923
Practice Address - Country:US
Practice Address - Phone:845-473-1188
Practice Address - Fax:845-473-0896
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237918207RC0000X
CAC53097207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02782896Medicaid
NY02782896Medicaid
NY704Q51Medicare PIN