Provider Demographics
NPI:1295393619
Name:BHAGWANDAS, RABINDRANAUTH
Entity Type:Individual
Prefix:
First Name:RABINDRANAUTH
Middle Name:
Last Name:BHAGWANDAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10419 130TH ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11419-3105
Mailing Address - Country:US
Mailing Address - Phone:347-306-5111
Mailing Address - Fax:
Practice Address - Street 1:10419 130TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11419-3105
Practice Address - Country:US
Practice Address - Phone:347-306-5111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-31
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010178-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health