Provider Demographics
NPI:1770622573
Name:DESHMUKH, AMIT ANIL (BS PHARMACY)
Entity type:Individual
Prefix:MR
First Name:AMIT
Middle Name:ANIL
Last Name:DESHMUKH
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 CLIFTON ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11735-5504
Mailing Address - Country:US
Mailing Address - Phone:631-270-4953
Mailing Address - Fax:
Practice Address - Street 1:799 FLUSHING AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-4107
Practice Address - Country:US
Practice Address - Phone:718-302-4850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048949183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00708558Medicaid