1700079787 NPI number — DR. PRATIKSHA DEENESH BHALEEYA MD

Table of content: DR. PRATIKSHA DEENESH BHALEEYA MD (NPI 1700079787)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700079787 NPI number — DR. PRATIKSHA DEENESH BHALEEYA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BHALEEYA
Provider First Name:
PRATIKSHA
Provider Middle Name:
DEENESH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1700079787
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 DEY ST
Provider Second Line Business Mailing Address:
UNIT # 355
Provider Business Mailing Address City Name:
JERSEY CITY
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07306-5149
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-907-2687
Provider Business Mailing Address Fax Number:
214-907-2687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1302 E 32ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILVER CITY
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88061-7215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-907-2687
Provider Business Practice Location Address Fax Number:
214-907-2687
Provider Enumeration Date:
08/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  ME108822 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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