MEDICARE: DR. SANJAY KANTU M.D.

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	207YP0228X	Pediatric Otolaryngology Physician	179541	NY
2	207YX0602X	Otolaryngic Allergy Physician	179541	NY
3	207YX0901X	Otology & Neurotology Physician	179541	NY
4	207YX0905X	Otolaryngology/Facial Plastic Surgery Physician	179541	NY

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	:	1952339806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANJAY KANTU M.D.

Provider Business Mailing Address
First Line	:	2204 VOORHIES AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2820
Country	:	US
Telephone Number	:	718-646-2500
Fax Number	:	718-648-4583

Provider Business Practice Location Address
First Line	:	2204 VOORHIES AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11235-2820
Country	:	US
Telephone Number	:	718-646-2500
Fax Number	:	718-648-4583

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	10/03/2012

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