Provider Demographics
NPI:1174538987
Name:MUKHOPADHYAY, SANJAY (MD)
Entity type:Individual
Prefix:
First Name:SANJAY
Middle Name:
Last Name:MUKHOPADHYAY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:750 E ADAMS ST
Mailing Address - Street 2:DEPARTMENT OF PATHOLOGY, SUNY UPSTATE MEDICAL UNIV.
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-2306
Mailing Address - Country:US
Mailing Address - Phone:315-464-4750
Mailing Address - Fax:315-464-7130
Practice Address - Street 1:750 E ADAMS ST
Practice Address - Street 2:DEPARTMENT OF PATHOLOGY, SUNY UPSTATE MEDICAL UNIV.
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-2306
Practice Address - Country:US
Practice Address - Phone:315-464-4750
Practice Address - Fax:315-464-7130
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2007-08-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN102391207ZP0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0007XAllopathic & Osteopathic PhysiciansPathologyMolecular Genetic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNI 57005Medicare UPIN