Healthcare Provider Details

I. General information

NPI: 1649499336
Provider Name (Legal Business Name): ANUPAMA DORAISWAMY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SUMMIT AVE
MONTVALE NJ
07645-1523
US

IV. Provider business mailing address

1275 YORK AVE
NEW YORK NY
10065-6007
US

V. Phone/Fax

Practice location:
  • Phone: 201-775-7000
  • Fax:
Mailing address:
  • Phone: 212-639-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number25MA08818000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: