Basic Information
| Provider Information | |||||||||
| NPI: | 1851514426 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BANDYOPADHYAY | ||||||||
| FirstName: | SAPTARSHI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BANERJEE | ||||||||
| OtherFirstName: | SAPTARSHI | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | MR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2100 WESCOTT DR RM 300A | ||||||||
| Address2: | 3RD FLOOR ROOM 300A | ||||||||
| City: | FLEMINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088224604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082375486 | ||||||||
| FaxNumber: | 9082375488 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 WESCOTT DRIVE ROOM 300A | ||||||||
| Address2: | 3RD FLOOR ROOM 300A | ||||||||
| City: | FLEMINGTON | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9082375486 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 10/15/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 10/15/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 125042932 | IL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 4301093956 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 25MA09839800 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4301093956 | 01 | MI | MICHIGAN | OTHER | 25MA09839800 | 01 | NJ | DIVISION OF CONSUMER AFFAIRS | OTHER | 1851514426 | 01 | MI | NPI | OTHER | 245455-1 | 01 | NY | NEW YORK | OTHER |