Provider Demographics
NPI:1598108185
Name:GUNASEKARAN, NIRANJAN (DO)
Entity Type:Individual
Prefix:
First Name:NIRANJAN
Middle Name:
Last Name:GUNASEKARAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4250 HEMPSTEAD TPKE
Mailing Address - Street 2:STE 17
Mailing Address - City:BETHPAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11714-5707
Mailing Address - Country:US
Mailing Address - Phone:516-735-5522
Mailing Address - Fax:
Practice Address - Street 1:4250 HEMPSTEAD TPKE STE 17
Practice Address - Street 2:
Practice Address - City:BETHPAGE
Practice Address - State:NY
Practice Address - Zip Code:11714-5707
Practice Address - Country:US
Practice Address - Phone:516-735-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-12
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS14133207R00000X
IL143357208M00000X
NY286211207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty