Provider Demographics
NPI:1336157643
Name:PANDYA, DIVYA (MD)
Entity Type:Individual
Prefix:DR
First Name:DIVYA
Middle Name:
Last Name:PANDYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DIVYA
Other - Middle Name:
Other - Last Name:PANDYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:264 02 HILLSIDE AVENUE
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11004
Mailing Address - Country:US
Mailing Address - Phone:718-343-7878
Mailing Address - Fax:718-343-1561
Practice Address - Street 1:264 02 HILLSIDE AVENUE
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11004
Practice Address - Country:US
Practice Address - Phone:718-343-7878
Practice Address - Fax:718-343-1561
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152379207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00759348Medicaid
NY00759348Medicaid
B79586Medicare UPIN