Provider Demographics
NPI:1699297689
Name:BHAISIN, ANJALI
Entity type:Individual
Prefix:
First Name:ANJALI
Middle Name:
Last Name:BHAISIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11797-2830
Mailing Address - Country:US
Mailing Address - Phone:347-761-9777
Mailing Address - Fax:
Practice Address - Street 1:6129 SPRINGFIELD BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2335
Practice Address - Country:US
Practice Address - Phone:718-428-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-11
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY062647183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist