Provider Demographics
NPI:1932167061
Name:NANDA, DEEPAK
Entity Type:Individual
Prefix:DR
First Name:DEEPAK
Middle Name:
Last Name:NANDA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6155 98TH ST
Mailing Address - Street 2:APT 1K
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1434
Mailing Address - Country:US
Mailing Address - Phone:718-271-1200
Mailing Address - Fax:718-271-1159
Practice Address - Street 1:6155 98TH ST
Practice Address - Street 2:APT 1K
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1434
Practice Address - Country:US
Practice Address - Phone:718-271-1200
Practice Address - Fax:718-271-1159
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173366207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E89262Medicare UPIN
NY01167028Medicare ID - Type Unspecified