Provider Demographics
NPI:1275588832
Name:PODDER, NITYANANDA (MD)
Entity Type:Individual
Prefix:
First Name:NITYANANDA
Middle Name:
Last Name:PODDER
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 1:19617 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2124
Mailing Address - Country:US
Mailing Address - Phone:718-479-3900
Mailing Address - Fax:718-479-1014
Practice Address - Street 1:19617 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2124
Practice Address - Country:US
Practice Address - Phone:718-479-3900
Practice Address - Fax:718-479-1014
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2375712084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY154829Medicare UPIN