Provider Demographics
NPI:1104897487
Name:PANDYA, SUNANDAN A (MD)
Entity type:Individual
Prefix:DR
First Name:SUNANDAN
Middle Name:A
Last Name:PANDYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GRAND STREET, 3RD FL
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-942-1001
Mailing Address - Fax:845-987-5979
Practice Address - Street 1:12 LIBERTY SQUARE MALL
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-2400
Practice Address - Country:US
Practice Address - Phone:845-942-1001
Practice Address - Fax:845-942-1431
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232059174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0117159OtherGHI PPO
NY232059OtherHIP
NY000000111587OtherGHI HMO
NY133693126OtherTAX ID #
NY02883998Medicaid
NY3949171OtherAETNA HMO
NY134SV1OtherEMPIRE BC STONY POINT
NY387708OtherCONNECTICARE
NYP3697187OtherOXFORD
NY7757719OtherAETNA PPO
NY134SV2OtherEMPIRE BC WEST NYACK
NY228830OtherUS FAMILY HEALTH PLAN
NY790824OtherMVP/TACONIC IPA
NY000000111587OtherGHI HMO
NYP3697187OtherOXFORD
NJ098819UMRMedicare PIN