Provider Demographics
NPI:1699970442
Name:KONDA, SANJIT R (MD)
Entity type:Individual
Prefix:DR
First Name:SANJIT
Middle Name:R
Last Name:KONDA
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 1:240 E 18TH ST STE 21
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3605
Mailing Address - Country:US
Mailing Address - Phone:212-598-3889
Mailing Address - Fax:
Practice Address - Street 1:240 E 18TH ST STE 21
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3605
Practice Address - Country:US
Practice Address - Phone:212-598-3889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261627207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03687116Medicaid
NC5903972Medicaid