Provider Demographics
NPI:1477733020
Name:HARINANDAN, BALDEO (RPH)
Entity Type:Individual
Prefix:
First Name:BALDEO
Middle Name:
Last Name:HARINANDAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 E 170TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-7013
Mailing Address - Country:US
Mailing Address - Phone:718-588-6825
Mailing Address - Fax:718-588-8710
Practice Address - Street 1:32 E 170TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-7013
Practice Address - Country:US
Practice Address - Phone:718-588-6825
Practice Address - Fax:718-588-8710
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046720183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01589106Medicaid