Provider Demographics
NPI:1669540761
Name:DHALLA, SATISH (MD)
Entity type:Individual
Prefix:DR
First Name:SATISH
Middle Name:
Last Name:DHALLA
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 1:111 BROADWAY FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-1995
Mailing Address - Country:US
Mailing Address - Phone:212-263-9700
Mailing Address - Fax:212-263-9701
Practice Address - Street 1:111 BROADWAY FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-1995
Practice Address - Country:US
Practice Address - Phone:212-263-9700
Practice Address - Fax:212-263-9701
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY127070207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB12373Medicare UPIN
NY291131Medicare ID - Type Unspecified