Provider Demographics
NPI:1548316664
Name:GOUNDER, MOHANAMBAL (MD)
Entity type:Individual
Prefix:DR
First Name:MOHANAMBAL
Middle Name:
Last Name:GOUNDER
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 1:1 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROOSEVELT ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10044-0052
Mailing Address - Country:US
Mailing Address - Phone:914-381-8900
Mailing Address - Fax:
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:
Practice Address - City:ROOSEVELT ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10044-0052
Practice Address - Country:US
Practice Address - Phone:914-381-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14544101207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14544101OtherNYS LICENSE
NYBG0135194OtherNYS DEA