=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710087382
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DR. DEBABRATA DUTTA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2006
-----------------------------------------------------
Last Update Date | 11/17/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 685 WHITE PLAINS RD
-----------------------------------------------------
City | EASTCHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10709-5545
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-787-4100
-----------------------------------------------------
Fax | 914-787-4199
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31 PONDFIELD RD W
-----------------------------------------------------
City | BRONXVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10708-2669
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 132718
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------