Provider Demographics
NPI:1336158609
Name:LAKHANI, NISHA (MD)
Entity Type:Individual
Prefix:DR
First Name:NISHA
Middle Name:
Last Name:LAKHANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 ROUTE 304
Mailing Address - Street 2:
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954-1614
Mailing Address - Country:US
Mailing Address - Phone:845-624-2929
Mailing Address - Fax:
Practice Address - Street 1:445 ROUTE 304
Practice Address - Street 2:
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-1614
Practice Address - Country:US
Practice Address - Phone:845-624-2929
Practice Address - Fax:845-624-2930
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY205907207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03139315Medicaid