Provider Demographics
NPI:1043298052
Name:BULSARA, GIRISH (MD FACP)
Entity Type:Individual
Prefix:
First Name:GIRISH
Middle Name:
Last Name:BULSARA
Suffix:
Gender:M
Credentials:MD FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 GREENWAY EAST
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:516-849-7854
Mailing Address - Fax:516-873-0786
Practice Address - Street 1:54 GREENWAY EAST
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:516-849-7854
Practice Address - Fax:516-873-0786
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196576173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01768354Medicaid
NY01768354Medicaid
NY087991Medicare PIN
NY07390GMedicare PIN