Provider Demographics
NPI:1851502181
Name:PANDEY, DIBYENDU S (PA)
Entity Type:Individual
Prefix:MR
First Name:DIBYENDU
Middle Name:S
Last Name:PANDEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17 SAXON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4813
Mailing Address - Country:US
Mailing Address - Phone:718-780-5686
Mailing Address - Fax:718-780-3105
Practice Address - Street 1:17 SAXON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4813
Practice Address - Country:US
Practice Address - Phone:718-780-5686
Practice Address - Fax:718-780-3105
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007543363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical