Provider Demographics
NPI:1700948825
Name:MUKHERJEE, NABENDU K (DDS)
Entity type:Individual
Prefix:
First Name:NABENDU
Middle Name:K
Last Name:MUKHERJEE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10159-0527
Mailing Address - Country:US
Mailing Address - Phone:917-608-7441
Mailing Address - Fax:
Practice Address - Street 1:208 E 116TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-1401
Practice Address - Country:US
Practice Address - Phone:212-722-7764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0503191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02339559Medicaid