Healthcare Provider Details

I. General information

NPI: 1457531873
Provider Name (Legal Business Name): NITHAN NARENDRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4422 3RD AVE DEPT. OF MEDICINE
BRONX NY
10457-2545
US

IV. Provider business mailing address

339 E 22ND ST APT. 1
NEW YORK NY
10010-4809
US

V. Phone/Fax

Practice location:
  • Phone: 718-960-6205
  • Fax:
Mailing address:
  • Phone: 516-849-7720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number244968
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: