Healthcare Provider Details

I. General information

NPI: 1992328264
Provider Name (Legal Business Name): ANOOSH ZAFAR GONDAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2020
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date: 01/18/2022
Reactivation Date: 04/14/2022

III. Provider practice location address

255 LAFAYETTE AVE
SUFFERN NY
10901-4812
US

IV. Provider business mailing address

255 LAFAYETTE AVE
SUFFERN NY
10901-4812
US

V. Phone/Fax

Practice location:
  • Phone: 845-368-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number326891
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD26737
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: