Healthcare Provider Details

I. General information

NPI: 1952339806
Provider Name (Legal Business Name): SANJAY KANTU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 VOORHIES AVE
BROOKLYN NY
11235-2820
US

IV. Provider business mailing address

2204 VOORHIES AVE
BROOKLYN NY
11235-2820
US

V. Phone/Fax

Practice location:
  • Phone: 718-646-2500
  • Fax: 718-648-4583
Mailing address:
  • Phone: 718-646-2500
  • Fax: 718-648-4583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number179541
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207YX0602X
TaxonomyOtolaryngic Allergy Physician
License Number179541
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number179541
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number179541
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: