Provider Demographics
NPI:1669428371
Name:BANERJEE, PUSHPAL ROCKY (DO)
Entity type:Individual
Prefix:DR
First Name:PUSHPAL
Middle Name:ROCKY
Last Name:BANERJEE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14050 NW 14TH ST
Mailing Address - Street 2:SUITE 190
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2865
Mailing Address - Country:US
Mailing Address - Phone:800-424-3672
Mailing Address - Fax:954-377-3042
Practice Address - Street 1:13021 W LINEBAUGH AVE STE 102
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-4509
Practice Address - Country:US
Practice Address - Phone:813-709-8567
Practice Address - Fax:215-642-8552
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8141207P00000X, 208D00000X
GA81748207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL260018800Medicaid
FL260018800Medicaid
FL35379DMedicare ID - Type Unspecified