Provider Demographics
NPI:1659538767
Name:SHIVENDER K. THAKUR PHYSICIAN PC
Entity Type:Organization
Organization Name:SHIVENDER K. THAKUR PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIVENDER
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:THAKUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-442-6960
Mailing Address - Street 1:890 WESTFALL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-2610
Mailing Address - Country:US
Mailing Address - Phone:585-442-6960
Mailing Address - Fax:585-442-3548
Practice Address - Street 1:890 WESTFALL RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-2610
Practice Address - Country:US
Practice Address - Phone:585-442-6960
Practice Address - Fax:585-442-3548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-18
Last Update Date:2008-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192844261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care