Provider Demographics
NPI:1811017486
Name:SANJAY BANERJI, M.D., INC.
Entity Type:Organization
Organization Name:SANJAY BANERJI, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DOBRZYNSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-481-0584
Mailing Address - Street 1:PO BOX 17959
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-0959
Mailing Address - Country:US
Mailing Address - Phone:213-481-0592
Mailing Address - Fax:213-481-0108
Practice Address - Street 1:1245 WILSHIRE BLVD
Practice Address - Street 2:SUITE 804
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4810
Practice Address - Country:US
Practice Address - Phone:213-977-0913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79467174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG98660Medicare UPIN
CAG79467Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER