Provider Demographics
NPI:1760825103
Name:GNANASEKARAN, JANSI (MD)
Entity Type:Individual
Prefix:
First Name:JANSI
Middle Name:
Last Name:GNANASEKARAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:665 SARATOGA RD STE 400
Mailing Address - Street 2:
Mailing Address - City:GANSEVOORT
Mailing Address - State:NY
Mailing Address - Zip Code:12831
Mailing Address - Country:US
Mailing Address - Phone:518-580-2185
Mailing Address - Fax:518-886-9721
Practice Address - Street 1:30 SHELBURNE RD
Practice Address - Street 2:DEPT. OF MEDICINE
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902
Practice Address - Country:US
Practice Address - Phone:203-276-7485
Practice Address - Fax:203-276-7368
Is Sole Proprietor?:No
Enumeration Date:2013-04-16
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY294792207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program