Healthcare Provider Details

I. General information

NPI: 1528081700
Provider Name (Legal Business Name): NUTAN ANAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CENTER DRIVE RIVERHEAD HEALTH CENTER
RIVERHEAD NY
11901-3398
US

IV. Provider business mailing address

300 CENTER DRIVE
RIVERHEAD NY
11901-3398
US

V. Phone/Fax

Practice location:
  • Phone: 631-852-1800
  • Fax:
Mailing address:
  • Phone: 631-852-1800
  • Fax: 631-852-1807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberNY141569
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: