Provider Demographics
NPI:1710286208
Name:AVI PANDEY, M.D., PC.
Entity Type:Organization
Organization Name:AVI PANDEY, M.D., PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AVI
Authorized Official - Middle Name:K
Authorized Official - Last Name:PANDEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-454-1040
Mailing Address - Street 1:8045 SURREY PL
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-1450
Mailing Address - Country:US
Mailing Address - Phone:718-454-1040
Mailing Address - Fax:718-454-7992
Practice Address - Street 1:6118 190TH ST
Practice Address - Street 2:SUITE 229
Practice Address - City:FRESH MEADOWS
Practice Address - State:NY
Practice Address - Zip Code:11365-2723
Practice Address - Country:US
Practice Address - Phone:718-454-1040
Practice Address - Fax:718-454-7992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171605174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1114040OtherUNITED HEALTHCARE
171605A71OtherHEALTHFIRST MEDICAID
DS459OtherOXFORD
0C8079OtherHEALTHNET
513607OtherAETNA
NY01457221Medicaid
36E363OtherBCBS
0006748OtherGHI
159853OtherELDERPLAN
36E361OtherEMPIRE MEDICARE
0801348OtherUNITED MEDICARE
180018329OtherRAILROAD MEDICARE
3938872Other1199 NATIONAL BENEFIT
36E363OtherBCBS
=========OtherHORIZON
0006748OtherGHI
=========OtherMULTIPLAN
NY01457221Medicaid
NY01457221Medicaid