Provider Demographics
NPI:1215007653
Name:KHOLWADWALA, DIPAK (MD)
Entity Type:Individual
Prefix:
First Name:DIPAK
Middle Name:
Last Name:KHOLWADWALA
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:NSUH-DEPT OF PEDIATRICS
Mailing Address - Street 2:300 COMMUNITY DRIVE
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030
Mailing Address - Country:US
Mailing Address - Phone:516-562-3078
Mailing Address - Fax:
Practice Address - Street 1:NSUH-DEPT OF PEDIATRICS
Practice Address - Street 2:300 COMMUNITY DRIVE
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030
Practice Address - Country:US
Practice Address - Phone:516-562-3078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1894362080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology