Provider Demographics
NPI:1972774248
Name:DILIP S. DOCTOR, MD PC
Entity type:Organization
Organization Name:DILIP S. DOCTOR, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD PC
Authorized Official - Prefix:
Authorized Official - First Name:DILIP
Authorized Official - Middle Name:S
Authorized Official - Last Name:DOCTOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-275-5800
Mailing Address - Street 1:98120 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-4357
Mailing Address - Country:US
Mailing Address - Phone:718-275-5800
Mailing Address - Fax:718-897-6767
Practice Address - Street 1:98120 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4357
Practice Address - Country:US
Practice Address - Phone:718-275-5800
Practice Address - Fax:718-897-6767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY122256174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE10717Medicare UPIN
NY88057Medicare PIN