Provider Demographics
NPI:1386718708
Name:MUKHERJEE, SIDDHARTHA (MD PHD)
Entity type:Individual
Prefix:DR
First Name:SIDDHARTHA
Middle Name:
Last Name:MUKHERJEE
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:TRUSTEES OF CU CITY OF NEW YORK HEM ONC
Mailing Address - Street 2:PO BOX 5073
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10087-5073
Mailing Address - Country:US
Mailing Address - Phone:212-305-0566
Mailing Address - Fax:212-305-6891
Practice Address - Street 1:161 FORT WASHINGTON AVENUE
Practice Address - Street 2:HEMATOLOGY ONCOLOGY
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-0566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY255578207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H66668Medicare UPIN