Provider Demographics
NPI:1790779957
Name:BANERJI, MARY ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:
Last Name:BANERJI
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 1:450 CLARKSON AVE
Mailing Address - Street 2:BOX 123
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-2056
Mailing Address - Country:US
Mailing Address - Phone:718-270-1542
Mailing Address - Fax:718-270-1534
Practice Address - Street 1:450 CLARKSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-2056
Practice Address - Country:US
Practice Address - Phone:718-270-1542
Practice Address - Fax:718-270-1534
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY138292-1207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02267650Medicaid
NY801031Medicare ID - Type Unspecified
NYG36849Medicare UPIN