Healthcare Provider Details

I. General information

NPI: 1962310599
Provider Name (Legal Business Name): EMERALD CITY MEDICAL PRACTICE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 UTE BLVD STE 370
PARK CITY UT
84098-7718
US

IV. Provider business mailing address

50 W BROADWAY STE 333
SALT LAKE CITY UT
84101-2027
US

V. Phone/Fax

Practice location:
  • Phone: 307-840-9834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: SANYAL DAY PALLABI
Title or Position: OWNER
Credential:
Phone: 806-319-3154