Provider Demographics
NPI:1659849032
Name:AHIR, BHAVESHKUMAR B
Entity Type:Individual
Prefix:
First Name:BHAVESHKUMAR
Middle Name:B
Last Name:AHIR
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 1:19617 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11423-2157
Mailing Address - Country:US
Mailing Address - Phone:718-479-3900
Mailing Address - Fax:718-479-1014
Practice Address - Street 1:19617 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:HOLLIS
Practice Address - State:NY
Practice Address - Zip Code:11423-2157
Practice Address - Country:US
Practice Address - Phone:718-479-3900
Practice Address - Fax:718-479-1014
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043563225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty