Provider Demographics
NPI:1730168956
Name:KIRTANE, SANJAY S (MD)
Entity type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:S
Last Name:KIRTANE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:114 12 BEACH CHANNEL DRIVE
Mailing Address - Street 2:SUITE 7
Mailing Address - City:ROCKAWY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694
Mailing Address - Country:US
Mailing Address - Phone:718-318-1029
Mailing Address - Fax:718-318-4602
Practice Address - Street 1:114 12 BEACH CHANNEL DRIVE
Practice Address - Street 2:SUITE 7
Practice Address - City:ROCKAWY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694
Practice Address - Country:US
Practice Address - Phone:718-318-1029
Practice Address - Fax:718-318-4602
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2010-10-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY137045207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG300012953Medicare PIN