Provider Demographics
NPI:1013074418
Name:BANERJEE, SUBHASHIS (MD)
Entity type:Individual
Prefix:DR
First Name:SUBHASHIS
Middle Name:
Last Name:BANERJEE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 TREETOPS CIR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-8581
Mailing Address - Country:US
Mailing Address - Phone:609-997-0690
Mailing Address - Fax:
Practice Address - Street 1:3551 LAWRENCEVILLE RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-4715
Practice Address - Country:US
Practice Address - Phone:609-252-7269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01068926A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A36726Medicare ID - Type Unspecified
I05742Medicare UPIN