Provider Demographics
NPI:1619176807
Name:SAMANTARA, SANDHYARANI (MD)
Entity Type:Individual
Prefix:
First Name:SANDHYARANI
Middle Name:
Last Name:SAMANTARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:670 STONELEIGH AVE
Mailing Address - Street 2:INTERNAL MEDICINE
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-3997
Mailing Address - Country:US
Mailing Address - Phone:845-279-5711
Mailing Address - Fax:845-278-5543
Practice Address - Street 1:670 STONELEIGH AVE
Practice Address - Street 2:INTERNAL MEDICINE
Practice Address - City:CARMEL
Practice Address - State:NY
Practice Address - Zip Code:10512-3997
Practice Address - Country:US
Practice Address - Phone:845-279-5711
Practice Address - Fax:845-278-5543
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY253355207R00000X, 208M00000X
CT67143207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03126309Medicaid
NYA400013731Medicare PIN