Provider Demographics
NPI:1417949421
Name:DAVE, HIRENDRA J (MD)
Entity Type:Individual
Prefix:DR
First Name:HIRENDRA
Middle Name:J
Last Name:DAVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HIRENDRAKUMAR
Other - Middle Name:JAGDISCHANDRA
Other - Last Name:DAVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:110 LOCKWOOD AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5028
Mailing Address - Country:US
Mailing Address - Phone:914-633-7200
Mailing Address - Fax:914-633-7217
Practice Address - Street 1:110 LOCKWOOD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5028
Practice Address - Country:US
Practice Address - Phone:914-633-7200
Practice Address - Fax:914-633-7217
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220558207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2623693OtherAETNA
NY02164767Medicaid
NYSD8951OtherBCBS
NY02164767Medicaid
2623693OtherAETNA