Provider Demographics
NPI:1235380296
Name:SIDHU, BIMALDEEP K (MD)
Entity Type:Individual
Prefix:DR
First Name:BIMALDEEP
Middle Name:K
Last Name:SIDHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MARLENE COURT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:L4L8L3
Mailing Address - Country:CA
Mailing Address - Phone:416-873-0023
Mailing Address - Fax:
Practice Address - Street 1:8216 PARSONS BLVD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1047
Practice Address - Country:US
Practice Address - Phone:646-421-4583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY265083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program