Provider Demographics
NPI:1770897753
Name:SANJAY KIRTANE PHYSICIAN PC
Entity type:Organization
Organization Name:SANJAY KIRTANE PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJAY
Authorized Official - Middle Name:SHREEDHAR
Authorized Official - Last Name:KIRTANE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-318-1029
Mailing Address - Street 1:11412 BEACH CHANNEL DR
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2212
Mailing Address - Country:US
Mailing Address - Phone:718-318-1029
Mailing Address - Fax:718-318-4802
Practice Address - Street 1:11412 BEACH CHANNEL DR
Practice Address - Street 2:SUITE 7
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2212
Practice Address - Country:US
Practice Address - Phone:718-318-1029
Practice Address - Fax:718-318-4802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137045207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00704889Medicaid
NY00704889Medicaid