Provider Demographics
NPI:1205022571
Name:S DANESH MD PC
Entity Type:Organization
Organization Name:S DANESH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:BACHULAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-343-1502
Mailing Address - Street 1:115 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020
Mailing Address - Country:US
Mailing Address - Phone:585-343-1502
Mailing Address - Fax:585-343-7202
Practice Address - Street 1:115 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020
Practice Address - Country:US
Practice Address - Phone:585-343-1502
Practice Address - Fax:585-343-7202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1054641208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYBA0174Medicare PIN