Provider Demographics
NPI:1245387257
Name:PATHAK, ANIL (MD)
Entity Type:Individual
Prefix:DR
First Name:ANIL
Middle Name:
Last Name:PATHAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W 57TH ST
Mailing Address - Street 2:APT # 42 D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3114
Mailing Address - Country:US
Mailing Address - Phone:212-245-0696
Mailing Address - Fax:
Practice Address - Street 1:506 LENOX AVENUE
Practice Address - Street 2:HARLEM HOSPITAL CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037
Practice Address - Country:US
Practice Address - Phone:212-939-8457
Practice Address - Fax:212-939-1891
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002337208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG71182Medicare UPIN