Provider Demographics
NPI:1265401152
Name:PALTA, SANJEEV (MD)
Entity type:Individual
Prefix:DR
First Name:SANJEEV
Middle Name:
Last Name:PALTA
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:PO BOX 750782
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-0782
Mailing Address - Country:US
Mailing Address - Phone:718-486-4278
Mailing Address - Fax:917-861-9527
Practice Address - Street 1:95 WYCKOFF AVE
Practice Address - Street 2:SUITE #1001
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-2927
Practice Address - Country:US
Practice Address - Phone:718-821-6285
Practice Address - Fax:718-821-1432
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA220423207RC0000X
NY220423207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02674413Medicaid
NYG46115Medicare UPIN
NY633Q11Medicare ID - Type Unspecified