Healthcare Provider Details

I. General information

NPI: 1326776170
Provider Name (Legal Business Name): ENRICHING LIVES THROUGH MEDICAL PHYSICIANS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 NEW YORK AVE
BROOKLYN NY
11203-5508
US

IV. Provider business mailing address

92 GREENWAY DR
STATEN ISLAND NY
10301-3366
US

V. Phone/Fax

Practice location:
  • Phone: 347-559-0133
  • Fax:
Mailing address:
  • Phone: 347-559-0133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ABHISHEK PANDEY
Title or Position: FOUNDER
Credential:
Phone: 347-559-0133