Provider Demographics
NPI:1033436019
Name:BHANUSALI, DHAVAL (MD)
Entity Type:Individual
Prefix:DR
First Name:DHAVAL
Middle Name:
Last Name:BHANUSALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:483 10TH AVE RM 310
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-9737
Mailing Address - Country:US
Mailing Address - Phone:917-970-9100
Mailing Address - Fax:
Practice Address - Street 1:483 10TH AVE RM 310
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-9737
Practice Address - Country:US
Practice Address - Phone:917-970-9100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-29
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY281484207N00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology