Provider Demographics
NPI:1477828960
Name:DILIP MUKHTYAR MD,PC
Entity Type:Organization
Organization Name:DILIP MUKHTYAR MD,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DILIP
Authorized Official - Middle Name:R
Authorized Official - Last Name:MUKHTYAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-863-2173
Mailing Address - Street 1:1521 BENSON ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-3151
Mailing Address - Country:US
Mailing Address - Phone:718-863-2173
Mailing Address - Fax:718-823-3926
Practice Address - Street 1:1521 BENSON ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-3151
Practice Address - Country:US
Practice Address - Phone:718-863-2173
Practice Address - Fax:718-823-3926
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DILIP MUKHTYAR MD,PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-15
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111730282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB17228Medicare UPIN