Provider Demographics
NPI:1679940993
Name:SINGH, BHAGWATTIE
Entity Type:Individual
Prefix:
First Name:BHAGWATTIE
Middle Name:
Last Name:SINGH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8916 WOODHAVEN BLVD
Mailing Address - Street 2:WOODHAVEN
Mailing Address - City:WOODHAVEN
Mailing Address - State:NY
Mailing Address - Zip Code:11421-2614
Mailing Address - Country:US
Mailing Address - Phone:718-847-4096
Mailing Address - Fax:
Practice Address - Street 1:8916 WOODHAVEN BLVD
Practice Address - Street 2:WOODHAVEN
Practice Address - City:WOODHAVEN
Practice Address - State:NY
Practice Address - Zip Code:11421-2614
Practice Address - Country:US
Practice Address - Phone:718-847-4096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-24
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1770517390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program