Provider Demographics
NPI:1609900844
Name:NEPHROLOGY PLLC
Entity Type:Organization
Organization Name:NEPHROLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MANASH
Authorized Official - Middle Name:K
Authorized Official - Last Name:DASGUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-376-3330
Mailing Address - Street 1:9A CENTRAL PARK AVE
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10705-4746
Mailing Address - Country:US
Mailing Address - Phone:914-376-3330
Mailing Address - Fax:
Practice Address - Street 1:9A CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10705-4746
Practice Address - Country:US
Practice Address - Phone:914-376-3330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY129957174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP412198OtherOXFORD
NYCK6794OtherRAILROAD MEDICARE
NY1000005074OtherAFFINITY HEALTH PLAN
NY00238615Medicaid
NY3300322OtherGHI
NY1000005074OtherAFFINITY HEALTH PLAN
NY00238615Medicaid