Provider Demographics
NPI:1295700375
Name:MAHAJAN, DEEPAK S (MD)
Entity type:Individual
Prefix:DR
First Name:DEEPAK
Middle Name:S
Last Name:MAHAJAN
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 1:38 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-1123
Mailing Address - Country:US
Mailing Address - Phone:516-627-4577
Mailing Address - Fax:
Practice Address - Street 1:38 LAKE DR
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-1123
Practice Address - Country:US
Practice Address - Phone:516-627-4577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY238466207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1724S1Medicare ID - Type Unspecified
NYI47095Medicare UPIN