Provider Demographics
NPI:1376567925
Name:DEEPAK S. MAHAJAN PHYSICIAN P.C
Entity Type:Organization
Organization Name:DEEPAK S. MAHAJAN PHYSICIAN P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTENDING
Authorized Official - Prefix:DR
Authorized Official - First Name:SUCHETA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MAHAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-627-4577
Mailing Address - Street 1:38 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1123
Mailing Address - Country:US
Mailing Address - Phone:516-627-4577
Mailing Address - Fax:718-523-2133
Practice Address - Street 1:8675 MIDLAND PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3058
Practice Address - Country:US
Practice Address - Phone:718-523-2177
Practice Address - Fax:718-523-2133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238466207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02752674Medicaid
NY1724S1Medicare ID - Type Unspecified
NY02752674Medicaid