Provider Demographics
NPI:1629012539
Name:SEN, DEBABRATA (MD)
Entity Type:Individual
Prefix:
First Name:DEBABRATA
Middle Name:
Last Name:SEN
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 1:80 MARCUS DR
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4230
Mailing Address - Country:US
Mailing Address - Phone:631-391-7889
Mailing Address - Fax:631-454-4163
Practice Address - Street 1:555 ROCKAWAY PKWY
Practice Address - Street 2:TJH MEDICAL SERVICES PC
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11212-3132
Practice Address - Country:US
Practice Address - Phone:718-240-5161
Practice Address - Fax:718-240-6924
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY218293207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02098520Medicaid
H21253Medicare UPIN
NY02098520Medicare ID - Type Unspecified