Provider Demographics
NPI:1689737744
Name:BHOIWALA, LAXMIKANT (MD)
Entity Type:Individual
Prefix:
First Name:LAXMIKANT
Middle Name:
Last Name:BHOIWALA
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 1:597 COLUMBIA TPKE
Mailing Address - Street 2:HANNAFORD PLAZA
Mailing Address - City:EAST GREENBUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12061-1602
Mailing Address - Country:US
Mailing Address - Phone:518-463-8262
Mailing Address - Fax:
Practice Address - Street 1:597 COLUMBIA TPKE
Practice Address - Street 2:HANNAFORD PLAZA
Practice Address - City:EAST GREENBUSH
Practice Address - State:NY
Practice Address - Zip Code:12061-1602
Practice Address - Country:US
Practice Address - Phone:518-463-8262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY197789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01575539Medicaid
F29146Medicare UPIN
NY01575539Medicaid