Provider Demographics
NPI:1760441117
Name:NANDLALL, BANEY (MD)
Entity Type:Individual
Prefix:
First Name:BANEY
Middle Name:
Last Name:NANDLALL
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 1:89-06 135 STREET
Mailing Address - Street 2:7L
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11418
Mailing Address - Country:US
Mailing Address - Phone:718-206-7820
Mailing Address - Fax:718-206-6786
Practice Address - Street 1:89-06 135 STREET
Practice Address - Street 2:2T
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11418
Practice Address - Country:US
Practice Address - Phone:718-206-6742
Practice Address - Fax:718-206-6905
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229304207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02514625Medicaid
NY0105TEMedicare ID - Type Unspecified
NY02514625Medicaid