Provider Demographics
NPI:1295773422
Name:BANERJEE, SANJOY (MD)
Entity type:Individual
Prefix:
First Name:SANJOY
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 1:2097 COMPTON AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-7282
Mailing Address - Country:US
Mailing Address - Phone:951-735-7246
Mailing Address - Fax:951-268-9516
Practice Address - Street 1:2097 COMPTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-7282
Practice Address - Country:US
Practice Address - Phone:951-735-7246
Practice Address - Fax:951-268-9516
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA90939207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A909390Medicaid
CA00A909390Medicare ID - Type Unspecified
I44738Medicare UPIN