Healthcare Provider Details

I. General information

NPI: 1306596648
Provider Name (Legal Business Name): SANJANA S MARIKUNTE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 YORK AVE FL 11
NEW YORK NY
10021-5663
US

IV. Provider business mailing address

1305 YORK AVE FL 11
NEW YORK NY
10021-5663
US

V. Phone/Fax

Practice location:
  • Phone: 646-962-2020
  • Fax: 646-962-0602
Mailing address:
  • Phone: 646-962-2020
  • Fax: 646-962-0602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number342067
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: