Provider Demographics
NPI:1891996542
Name:BHANDARKAR, SHYAMKISHORE MORESHWAR (MD)
Entity Type:Individual
Prefix:DR
First Name:SHYAMKISHORE
Middle Name:MORESHWAR
Last Name:BHANDARKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:S
Other - Middle Name:MADHUSUDAN
Other - Last Name:BHANDARKAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2
Mailing Address - Street 2:
Mailing Address - City:NEW HAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:10958
Mailing Address - Country:US
Mailing Address - Phone:845-374-8138
Mailing Address - Fax:845-374-8138
Practice Address - Street 1:270 GREEVES ROAD
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:10958
Practice Address - Country:US
Practice Address - Phone:845-374-8138
Practice Address - Fax:845-374-8138
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118002208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
B17449Medicare UPIN