Provider Demographics
NPI:1619125135
Name:DIXIT, DIVY
Entity Type:Individual
Prefix:MR
First Name:DIVY
Middle Name:
Last Name:DIXIT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-2029
Mailing Address - Country:US
Mailing Address - Phone:718-220-2748
Mailing Address - Fax:718-220-2749
Practice Address - Street 1:2200 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-2029
Practice Address - Country:US
Practice Address - Phone:718-220-2748
Practice Address - Fax:718-220-2749
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049976-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist