Provider Demographics
NPI:1497374359
Name:MEDICAL HEALTH 360 PLLC
Entity Type:Organization
Organization Name:MEDICAL HEALTH 360 PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TATTVAMASI
Authorized Official - Middle Name:
Authorized Official - Last Name:PARIKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-724-7339
Mailing Address - Street 1:117 GREENWAY W
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-2226
Mailing Address - Country:US
Mailing Address - Phone:888-860-0507
Mailing Address - Fax:
Practice Address - Street 1:16955 COUNTY ROUTE 59
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:NY
Practice Address - Zip Code:13634-2027
Practice Address - Country:US
Practice Address - Phone:888-860-0507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-10
Last Update Date:2020-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14442662Medicaid