Provider Demographics
NPI:1760433031
Name:DHANJAL, SATBACHAN SINGH (MD)
Entity Type:Individual
Prefix:DR
First Name:SATBACHAN
Middle Name:SINGH
Last Name:DHANJAL
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 1:20707 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-1732
Mailing Address - Country:US
Mailing Address - Phone:718-464-9727
Mailing Address - Fax:718-464-9735
Practice Address - Street 1:20707 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-1732
Practice Address - Country:US
Practice Address - Phone:718-464-9727
Practice Address - Fax:718-464-9735
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135215207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY135215OtherSTATE LICENSE
NY00423478Medicaid
NY12772Medicare ID - Type Unspecified
NY135215OtherSTATE LICENSE