Provider Demographics
NPI:1619287364
Name:SANJOY BANERJEE MD INC
Entity Type:Organization
Organization Name:SANJOY BANERJEE MD INC
Other - Org Name:PACIFIC PAIN CARE CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANJOY
Authorized Official - Middle Name:
Authorized Official - Last Name:BANERJEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-735-7246
Mailing Address - Street 1:2097 COMPTON AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-7282
Mailing Address - Country:US
Mailing Address - Phone:951-735-7246
Mailing Address - Fax:951-268-9516
Practice Address - Street 1:2097 COMPTON AVE
Practice Address - Street 2:STE 102
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7282
Practice Address - Country:US
Practice Address - Phone:951-735-7246
Practice Address - Fax:951-268-9516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90939207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1295773422OtherINDIVIDUAL NPI
CA1619287365Medicaid
CAEG102AMedicare PIN