Healthcare Provider Details

I. General information

NPI: 1275187817
Provider Name (Legal Business Name): SAMEER DATTA KANDHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE
BRONX NY
10457-7697
US

IV. Provider business mailing address

1770 GRAND CONCOURSE APT 3C
BRONX NY
10457-5560
US

V. Phone/Fax

Practice location:
  • Phone: 718-590-1800
  • Fax:
Mailing address:
  • Phone: 646-874-9164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberW1818
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: