Provider Demographics
NPI:1386688273
Name:SAXENA, MRIDULA (MD)
Entity Type:Individual
Prefix:
First Name:MRIDULA
Middle Name:
Last Name:SAXENA
Suffix:
Gender:F
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:89-06 135TH STREET
Mailing Address - Street 2:7L
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11418
Mailing Address - Country:US
Mailing Address - Phone:718-206-6984
Mailing Address - Fax:718-206-6786
Practice Address - Street 1:1 BROOKDALE PLAZA
Practice Address - Street 2:TJH MEDICAL SERVICES PC RM 107 AARON
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212
Practice Address - Country:US
Practice Address - Phone:718-240-5236
Practice Address - Fax:718-240-6592
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2010-07-13
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Provider Licenses
StateLicense IDTaxonomies
NY121797207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00249918Medicaid
C08246Medicare UPIN
NY00249918Medicaid