Provider Demographics
NPI:1275556862
Name:DAS, ANNADA KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:ANNADA
Middle Name:KUMAR
Last Name:DAS
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 1:70 PINEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-1512
Mailing Address - Country:US
Mailing Address - Phone:516-365-8654
Mailing Address - Fax:
Practice Address - Street 1:2601 OCEAN PKWY
Practice Address - Street 2:2949 BRIGHTON 4TH STREET
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-7745
Practice Address - Country:US
Practice Address - Phone:718-934-3353
Practice Address - Fax:718-769-8428
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153357-1207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00912125Medicaid
NY00912125Medicaid
NYE04058Medicare UPIN