MEDICARE: DR. SANJIT R KONDA M.D.

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
1	207X00000X	Orthopaedic Surgery Physician	261627	NY

Other Identifiers

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

General Provider Information

NPI Number	:	1699970442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANJIT R KONDA M.D.

Provider Business Mailing Address
First Line	:	240 E 18TH ST STE 21
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-3605
Country	:	US
Telephone Number	:	212-598-3889
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 E 18TH ST STE 21
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10003-3605
Country	:	US
Telephone Number	:	212-598-3889
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2007
Last Update Date	:	03/09/2021

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