Healthcare Provider Details

I. General information

NPI: 1467198655
Provider Name (Legal Business Name): ISHAN SAHU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2875 BROADWAY FL 2
NEW YORK NY
10025-7846
US

IV. Provider business mailing address

2875 BROADWAY FL 2
NEW YORK NY
10025-7846
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-1600
  • Fax:
Mailing address:
  • Phone: 212-523-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number346047
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: