Healthcare Provider Details

I. General information

NPI: 1790945277
Provider Name (Legal Business Name): SIMA SUHAS PENDHARKAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2008
Last Update Date: 12/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 CONCORD STREET 2A
BROOKLYN NY
11201-4013
US

IV. Provider business mailing address

177 CONCORD ST 2A
BROOKLYN NY
11201-2021
US

V. Phone/Fax

Practice location:
  • Phone: 919-360-2987
  • Fax:
Mailing address:
  • Phone: 212-523-5918
  • Fax: 212-523-2842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number276425
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: