Provider Demographics
NPI:1528081700
Name:ANAND, NUTAN (MD)
Entity type:Individual
Prefix:DR
First Name:NUTAN
Middle Name:
Last Name:ANAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 CENTER DRIVE
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-3398
Mailing Address - Country:US
Mailing Address - Phone:631-852-1800
Mailing Address - Fax:631-852-1807
Practice Address - Street 1:300 CENTER DRIVE
Practice Address - Street 2:RIVERHEAD HEALTH CENTER
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3398
Practice Address - Country:US
Practice Address - Phone:631-852-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYNY141569208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY547806Medicaid
NY547806Medicaid
NYNA022D7110Medicare ID - Type Unspecified