Provider Demographics
NPI:1306995147
Name:DAVE, BIPINCHANDRA VAJESHANKER
Entity type:Individual
Prefix:
First Name:BIPINCHANDRA
Middle Name:VAJESHANKER
Last Name:DAVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BIPINCHANDRA
Other - Middle Name:V
Other - Last Name:DAVE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:115 WEST 116TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026
Mailing Address - Country:US
Mailing Address - Phone:212-961-5741
Mailing Address - Fax:212-865-3581
Practice Address - Street 1:115 W 116TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-2521
Practice Address - Country:US
Practice Address - Phone:212-961-5741
Practice Address - Fax:212-865-3581
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY29832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY29832OtherPHARMACIST