Basic Information
Provider Information
NPI: 1578759338
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHARMA
FirstName: DEEP
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3411 WAYNE AVE
Address2: 5TH FLOOR
City: BRONX
State: NY
PostalCode: 104672509
CountryCode: US
TelephoneNumber: 8666338255
FaxNumber: 7186528384
Practice Location
Address1: 3411 WAYNE AVE
Address2: 5TH FLOOR
City: BRONX
State: NY
PostalCode: 104672509
CountryCode: US
TelephoneNumber: 8666338255
FaxNumber: 7186528384
Other Information
ProviderEnumerationDate: 09/14/2007
LastUpdateDate: 01/29/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RN0300X266341NYY Allopathic & Osteopathic PhysiciansInternal MedicineNephrology

No ID Information.


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