Provider Demographics
NPI:1376545814
Name:DHALLA, MINAKSHI (MD)
Entity Type:Individual
Prefix:DR
First Name:MINAKSHI
Middle Name:
Last Name:DHALLA
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 1:731 WHITE PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473-2631
Mailing Address - Country:US
Mailing Address - Phone:718-589-8324
Mailing Address - Fax:718-378-2880
Practice Address - Street 1:165 E BURNSIDE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453-4104
Practice Address - Country:US
Practice Address - Phone:718-589-8324
Practice Address - Fax:718-378-2880
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149507208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00665274Medicaid
NY74A771Medicare ID - Type Unspecified
NY00665274Medicaid