Provider Demographics
NPI:1437484342
Name:ANITA BHOLA MEDICAL, P.C.
Entity Type:Organization
Organization Name:ANITA BHOLA MEDICAL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:
Authorized Official - Last Name:BHOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-348-2209
Mailing Address - Street 1:PO BOX 612
Mailing Address - Street 2:
Mailing Address - City:MILLWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:10546-0612
Mailing Address - Country:US
Mailing Address - Phone:845-348-2209
Mailing Address - Fax:
Practice Address - Street 1:160 N MIDLAND AVE
Practice Address - Street 2:NYACK HOSPITAL
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1912
Practice Address - Country:US
Practice Address - Phone:845-348-2209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2017-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY182716207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Single Specialty