Provider Demographics
NPI:1861530446
Name:DATTA, MOITRI NATH (MD)
Entity type:Individual
Prefix:DR
First Name:MOITRI
Middle Name:NATH
Last Name:DATTA
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 1:9 OVERHILL RD
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-5307
Mailing Address - Country:US
Mailing Address - Phone:914-723-3247
Mailing Address - Fax:914-723-4211
Practice Address - Street 1:510 N BROADWAY
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-3217
Practice Address - Country:US
Practice Address - Phone:914-723-3247
Practice Address - Fax:914-723-4211
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1389972084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00423294Medicaid
NY138997OtherMEDICAL LICENSE
NY138997OtherMEDICAL LICENSE
NY00423294Medicaid
CO5792Medicare UPIN