Provider Demographics
NPI:1568484061
Name:DHARIA, NIMISH SHAILESH (MD)
Entity Type:Individual
Prefix:
First Name:NIMISH
Middle Name:SHAILESH
Last Name:DHARIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 LAKEVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:516-328-9797
Mailing Address - Fax:516-352-6579
Practice Address - Street 1:2035 LAKEVILLE ROAD
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:576-328-9797
Practice Address - Fax:576-352-6579
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215489207R00000X, 207RC0000X, 207UN0903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207UN0903XAllopathic & Osteopathic PhysiciansNuclear MedicineIn Vivo & In Vitro Nuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02618793Medicaid
NY02618793Medicaid
H37632Medicare UPIN