Healthcare Provider Details

I. General information

NPI: 1265401152
Provider Name (Legal Business Name): SANJEEV PALTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 10/06/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 WYCKOFF AVE SUITE #1001
BROOKLYN NY
11237-2927
US

IV. Provider business mailing address

PO BOX 750782
FOREST HILLS NY
11375-0782
US

V. Phone/Fax

Practice location:
  • Phone: 718-821-6285
  • Fax: 718-821-1432
Mailing address:
  • Phone: 718-486-4278
  • Fax: 917-861-9527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMA220423
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number220423
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number220423
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: