Provider Demographics
NPI:1750309480
Name:BAVISKAR, PRAVIN C (RPH)
Entity Type:Individual
Prefix:MR
First Name:PRAVIN
Middle Name:C
Last Name:BAVISKAR
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 WEST ST
Mailing Address - Street 2:
Mailing Address - City:CLOSTER
Mailing Address - State:NJ
Mailing Address - Zip Code:07624-1220
Mailing Address - Country:US
Mailing Address - Phone:201-784-3419
Mailing Address - Fax:
Practice Address - Street 1:53 E 34TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4332
Practice Address - Country:US
Practice Address - Phone:212-683-3838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030421-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist