| NPI |
1710336169 |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
| Entity Type Code |
1 |
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot
include a Post Office box. |
| Provider Last Name Legal Name |
MUKHOPADHYAY |
The city name in the location address of the provider being identified. |
| Provider First Name |
AMRITA |
The State code in the location of the provider
being identified. |
| Provider Credential Text |
M.D. |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
| Provider First Line Business Practice Location Address |
550 1ST AVE |
The country code in the location address of the provider being identified. |
| Provider Business Practice Location Address City Name |
NEW YORK |
The telephone number associated with the location address of the provider being identified. |
| Provider Business Practice Location Address State Name |
NY |
The fax number associated with the location
address of the provider being identified. |
| Provider Business Practice Location Address Postal Code |
100166402 |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Provider Business Practice Location Address Country Code If outside U S |
US |
The date that a record was last updated or changed. |
| Provider Business Practice Location Address Telephone Number |
6469297800 |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
| Provider Enumeration Date |
6/7/2016 |
The first name of the authorized official. |
| Last Update Date |
5/9/2022 |
The middle name of the authorized official. |
| Provider Gender Code |
F |
The title or position of the authorized official. |
| Healthcare Provider Taxonomy Code 1 |
390200000X |
The 10-position telephone number of the authorized official. |
| Provider License Number 1 |
268229 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider License Number State Code 1 |
MA |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Healthcare Provider Primary Taxonomy Switch 1 |
N |
|
| Healthcare Provider Taxonomy Code 2 |
207RC0000X |
|
| Provider License Number 2 |
297896-01 |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Provider License Number State Code 2 |
NY |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Healthcare Provider Primary Taxonomy Switch 2 |
Y |
|
| Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
| NPI Certification Date |
5/9/2022 |
|