Provider Demographics
NPI:1992368567
Name:BIJUKSHE, SAFAL (MD)
Entity Type:Individual
Prefix:MR
First Name:SAFAL
Middle Name:
Last Name:BIJUKSHE
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 1:465 GYPSY LANE APT 304
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504
Mailing Address - Country:US
Mailing Address - Phone:330-884-3573
Mailing Address - Fax:330-884-5688
Practice Address - Street 1:1350 EAST MARKET STREET
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483
Practice Address - Country:US
Practice Address - Phone:330-841-9011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-18
Last Update Date:2019-12-23
Deactivation Date:2019-12-04
Deactivation Code:
Reactivation Date:2019-12-20
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program