MEDICARE: DR. PUSHPAL ROCKY BANERJEE DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	OS8141	FL
2	208D00000X	General Practice Physician	OS8141	FL
3	207P00000X	Emergency Medicine Physician	81748	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669428371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PUSHPAL ROCKY BANERJEE DO

Provider Business Mailing Address
First Line	:	14050 NW 14TH ST
Second Line	:	SUITE 190
City	:	SUNRISE
State	:	FL
Zip	:	33323-2865
Country	:	US
Telephone Number	:	800-424-3672
Fax Number	:	954-377-3042

Provider Business Practice Location Address
First Line	:	13021 W LINEBAUGH AVE STE 102
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-4509
Country	:	US
Telephone Number	:	813-709-8567
Fax Number	:	215-642-8552

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	01/30/2025

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