1356613608 NPI number — PARUL DUA MAKKAR DDS, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356613608 NPI number — PARUL DUA MAKKAR DDS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARUL DUA MAKKAR DDS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356613608
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121-02 LIBERTY AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
S. RICHMOND HILL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11419-2112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-641-1160
Provider Business Mailing Address Fax Number:
718-641-1167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121-02 LIBERTY AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
S. RICHMOND HILL
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11419-2112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-641-1160
Provider Business Practice Location Address Fax Number:
718-641-1167
Provider Enumeration Date:
02/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
MAKKAR
Authorized Official First Name:
PARUL
Authorized Official Middle Name:
DUA
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
718-641-1160

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  053657 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 02966310 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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