Provider Demographics
NPI:1770749616
Name:MUKHERJEE, INDRANEIL (MD , MBBS)
Entity type:Individual
Prefix:DR
First Name:INDRANEIL
Middle Name:
Last Name:MUKHERJEE
Suffix:
Gender:M
Credentials:MD , MBBS
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:ONE EDGEWATER STREET
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10305
Mailing Address - Country:US
Mailing Address - Phone:718-226-1375
Mailing Address - Fax:718-226-1039
Practice Address - Street 1:256 MASON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10305-3408
Practice Address - Country:US
Practice Address - Phone:718-226-1300
Practice Address - Fax:718-226-1247
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY287435208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery