Provider Demographics
NPI:1790027001
Name:VIRAJ V. GADKAR D.M.D. P.C.
Entity Type:Organization
Organization Name:VIRAJ V. GADKAR D.M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIRAJ
Authorized Official - Middle Name:V
Authorized Official - Last Name:GADKAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:516-868-1892
Mailing Address - Street 1:5 ALBERGO LN
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3847
Mailing Address - Country:US
Mailing Address - Phone:516-729-6355
Mailing Address - Fax:
Practice Address - Street 1:245 NASSAU RD
Practice Address - Street 2:
Practice Address - City:ROOSEVELT
Practice Address - State:NY
Practice Address - Zip Code:11575-1736
Practice Address - Country:US
Practice Address - Phone:516-868-1892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054052122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03026753Medicaid