Provider Demographics
NPI:1245517507
Name:DEVENDRA K SINGH MDPC
Entity type:Organization
Organization Name:DEVENDRA K SINGH MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVENDRA
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-878-4377
Mailing Address - Street 1:41 BAY AVE
Mailing Address - Street 2:
Mailing Address - City:EAST MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11940-1209
Mailing Address - Country:US
Mailing Address - Phone:631-878-4377
Mailing Address - Fax:631-878-5587
Practice Address - Street 1:41 BAY AVE
Practice Address - Street 2:
Practice Address - City:EAST MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11940-1209
Practice Address - Country:US
Practice Address - Phone:631-878-4377
Practice Address - Fax:631-878-5587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123643261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00232540Medicaid
NY00232540Medicaid