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NPI Code Detail

MEDICARE: DEBA BANERJI MD

MEDICARE:   DEBA  BANERJI  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician192748NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1073574240
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBA BANERJI MD
Provider Business Mailing Address
First Line : 2791 RICHMOND AVE
Second Line : 2ND FLOOR
City : STATEN ISLAND
State : NY
Zip : 10314-5859
Country : US
Telephone Number : 718-816-6440
Fax Number : 718-948-8433
Provider Business Practice Location Address
First Line : 4771 HYLAN BLVD
Second Line :
City : STATEN ISLAND
State : NY
Zip : 10312-6315
Country : US
Telephone Number : 718-948-8200
Fax Number : 718-948-8433
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2006
Last Update Date : 11/12/2012

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Directions to “ DEBA BANERJI MD” Practice Location

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