Healthcare Provider Details

I. General information

NPI: 1770749616
Provider Name (Legal Business Name): INDRANEIL MUKHERJEE M.D. , M.B.B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

256 MASON AVE
STATEN ISLAND NY
10305-3408
US

IV. Provider business mailing address

ONE EDGEWATER STREET 5TH FLOOR
STATEN ISLAND NY
10305
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-1300
  • Fax: 718-226-1247
Mailing address:
  • Phone: 718-226-1375
  • Fax: 718-226-1039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number287435
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: