Provider Demographics
NPI:1518368141
Name:BANERJEE, NIRMALYA (MD)
Entity Type:Individual
Prefix:MR
First Name:NIRMALYA
Middle Name:
Last Name:BANERJEE
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 1:6601 110TH ST
Mailing Address - Street 2:APT 1B
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1988
Mailing Address - Country:US
Mailing Address - Phone:225-747-2415
Mailing Address - Fax:
Practice Address - Street 1:6601 110TH ST
Practice Address - Street 2:APT 1B
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1988
Practice Address - Country:US
Practice Address - Phone:225-747-2415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-15
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ390200000X
390200000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty