Provider Demographics
NPI:1205844503
Name:BHANUSALI, GOVINDLAL K (MD)
Entity Type:Individual
Prefix:DR
First Name:GOVINDLAL
Middle Name:K
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 1:15 DUNNING ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-2212
Mailing Address - Country:US
Mailing Address - Phone:845-342-1553
Mailing Address - Fax:845-343-3723
Practice Address - Street 1:15 DUNNING ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2212
Practice Address - Country:US
Practice Address - Phone:845-342-1553
Practice Address - Fax:845-343-3723
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1533391207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01276291Medicaid
02D991Medicare ID - Type Unspecified
A96921Medicare UPIN