Provider Demographics
NPI:1457414526
Name:PARAB, SANGITA SANTOSH (MD)
Entity Type:Individual
Prefix:DR
First Name:SANGITA
Middle Name:SANTOSH
Last Name:PARAB
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 WESTWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-5363
Mailing Address - Country:US
Mailing Address - Phone:718-981-7805
Mailing Address - Fax:
Practice Address - Street 1:2435 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-6633
Practice Address - Country:US
Practice Address - Phone:718-667-6500
Practice Address - Fax:718-667-6501
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08197400207R00000X
NY242701207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY242701OtherNY LICENSE
NY02840417Medicaid
A400019641Medicare PIN