Healthcare Provider Details

I. General information

NPI: 1295700375
Provider Name (Legal Business Name): DEEPAK S MAHAJAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 LAKE DR
NEW HYDE PARK NY
11040-1123
US

IV. Provider business mailing address

38 LAKE DR
NEW HYDE PARK NY
11040-1123
US

V. Phone/Fax

Practice location:
  • Phone: 516-627-4577
  • Fax:
Mailing address:
  • Phone: 516-627-4577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number238466
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: