Provider Demographics
NPI:1528232873
Name:RAKESH K DUA PHYSICIAN, PC
Entity Type:Organization
Organization Name:RAKESH K DUA PHYSICIAN, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-968-2534
Mailing Address - Street 1:6 MEADOWBROOK LN
Mailing Address - Street 2:
Mailing Address - City:OLD WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11568-1112
Mailing Address - Country:US
Mailing Address - Phone:718-968-2534
Mailing Address - Fax:718-968-0573
Practice Address - Street 1:2035 RALPH AVE
Practice Address - Street 2:SUITE B8
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-5300
Practice Address - Country:US
Practice Address - Phone:718-968-2534
Practice Address - Fax:718-968-0573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY208733208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01623014Medicaid