Provider Demographics
NPI:1801050448
Name:DEBNATH, SUBODH KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:SUBODH
Middle Name:KUMAR
Last Name:DEBNATH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:571 SAINT JOSEPHS BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:
Practice Address - Street 1:100 JOHN ROEMMELT DR
Practice Address - Street 2:SUITE 301
Practice Address - City:HORSEHEADS
Practice Address - State:NY
Practice Address - Zip Code:14845-8301
Practice Address - Country:US
Practice Address - Phone:607-739-0352
Practice Address - Fax:607-739-6909
Is Sole Proprietor?:No
Enumeration Date:2008-07-14
Last Update Date:2022-04-26
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Provider Licenses
StateLicense IDTaxonomies
NY253780207R00000X
PAMD437923207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03140127Medicaid
NYJ400066840Medicare PIN
NYJ400007337Medicare PIN