Basic Information
| Provider Information | |||||||||
| NPI: | 1063412872 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DASGUPTA | ||||||||
| FirstName: | INDIRA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 E 233RD ST | ||||||||
| Address2: | DEPT. OF PEDIATRICS | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104662604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144937997 | ||||||||
| FaxNumber: | 9145944022 | ||||||||
| Practice Location | |||||||||
| Address1: | 600 E 233RD ST | ||||||||
| Address2: | |||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 104662604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9144937997 | ||||||||
| FaxNumber: | 9145944022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2005 | ||||||||
| LastUpdateDate: | 09/26/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0207X | 132189 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
ID Information
| ID | Type | State | Issuer | Description | 00728198 | 05 | NY | MEDICAID |