Provider Demographics
NPI:1851513949
Name:SANJAY SEN MD PC
Entity Type:Organization
Organization Name:SANJAY SEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:SEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-648-0000
Mailing Address - Street 1:531 N FRANKLIN ST
Mailing Address - Street 2:A
Mailing Address - City:SHAMOKIN
Mailing Address - State:PA
Mailing Address - Zip Code:17872-6754
Mailing Address - Country:US
Mailing Address - Phone:570-648-0000
Mailing Address - Fax:570-648-0896
Practice Address - Street 1:531 N FRANKLIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:SHAMOKIN
Practice Address - State:PA
Practice Address - Zip Code:17872-6754
Practice Address - Country:US
Practice Address - Phone:570-648-0000
Practice Address - Fax:570-648-0896
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SANJAY SEN MD PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-02
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072254L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH28405Medicare UPIN
PASE043776Medicare PIN
PAH28405Medicare UPIN