Provider Demographics
NPI:1588782916
Name:MRUDANGI THAKUR PLASTIC & RECONSTRUCTIVE SURGERY PC
Entity type:Organization
Organization Name:MRUDANGI THAKUR PLASTIC & RECONSTRUCTIVE SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MRUDANGI
Authorized Official - Middle Name:SHASHIKANT
Authorized Official - Last Name:THAKUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-962-8888
Mailing Address - Street 1:3650 HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10535-1500
Mailing Address - Country:US
Mailing Address - Phone:914-962-8888
Mailing Address - Fax:914-962-8881
Practice Address - Street 1:3650 HILL BLVD
Practice Address - Street 2:
Practice Address - City:JEFFERSON VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10535-1500
Practice Address - Country:US
Practice Address - Phone:914-962-8888
Practice Address - Fax:914-962-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210957208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty