Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YP0228X | Pediatric Otolaryngology | 179541 | NY |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 179541 | NY |
NPI | 1952339806 |
---|---|
Provider Name | Dr. Sanjay Kantu |
First Address | Brooklyn, NY 11235-2820 |
Second Address | Brooklyn, NY 11235-2820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 03/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01859636 | (05) | NY |
G63731 | (02) | NY |