Provider Demographics
NPI:1821037508
Name:ROY, DILIP K
Entity Type:Individual
Prefix:DR
First Name:DILIP
Middle Name:K
Last Name:ROY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 GENESEE ST
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413-2334
Mailing Address - Country:US
Mailing Address - Phone:315-732-9368
Mailing Address - Fax:315-732-9403
Practice Address - Street 1:941 S 1ST ST
Practice Address - Street 2:FASTCARE FAMILY MEDICAL
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-4989
Practice Address - Country:US
Practice Address - Phone:315-593-7128
Practice Address - Fax:315-598-8409
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY216564-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02116172Medicaid
NY02116172Medicaid
CC9482Medicare ID - Type Unspecified
NYJ400003946Medicare PIN
NY02116172Medicaid