Provider Demographics
NPI:1851403646
Name:INTERNAL MEDICINE CLINIC BANERJI LTD
Entity Type:Organization
Organization Name:INTERNAL MEDICINE CLINIC BANERJI LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BASHAB
Authorized Official - Middle Name:
Authorized Official - Last Name:BANERJI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-740-5311
Mailing Address - Street 1:5731 SOUTH FORT APACHE ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148
Mailing Address - Country:US
Mailing Address - Phone:702-740-5311
Mailing Address - Fax:702-740-5310
Practice Address - Street 1:5731 S FORT APACHE RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-5620
Practice Address - Country:US
Practice Address - Phone:702-740-5311
Practice Address - Fax:702-740-5310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9544261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDD5081OtherRAILROAD MEDICARE
NVDD5081OtherRAILROAD MEDICARE
NV38616Medicare PIN