Provider Demographics
NPI:1841366762
Name:DAS, NAYAN KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:NAYAN
Middle Name:KUMAR
Last Name:DAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5014 16TH AVE STE 13
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-1404
Mailing Address - Country:US
Mailing Address - Phone:914-359-4420
Mailing Address - Fax:914-355-3035
Practice Address - Street 1:8230 E MAIN RD
Practice Address - Street 2:
Practice Address - City:LE ROY
Practice Address - State:NY
Practice Address - Zip Code:14482-9739
Practice Address - Country:US
Practice Address - Phone:914-359-4420
Practice Address - Fax:914-355-3035
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY136944208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMD885ROtherPREFERRED CARE
NYNKU823144OtherBLUE SHIELD ROCHESTER
NY00463350Medicaid
NY20957401OtherUNIVERA
NY008082961OtherBLUE CROSS WNY
NYMD885ROtherPREFERRED CARE