Provider Demographics
NPI:1780699348
Name:SUBHEDAR, DILIP V (MD)
Entity type:Individual
Prefix:DR
First Name:DILIP
Middle Name:V
Last Name:SUBHEDAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 GRAND ST FL 3
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-1035
Mailing Address - Country:US
Mailing Address - Phone:845-353-5600
Mailing Address - Fax:804-261-4904
Practice Address - Street 1:257 LAFAYETTE AVE STE 285
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4837
Practice Address - Country:US
Practice Address - Phone:845-353-5600
Practice Address - Fax:804-261-4904
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05330700207L00000X, 208VP0014X
NY183858-1207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02839641Medicaid
NJ0016063Medicaid
PA0017911420001Medicaid
NJ0016063Medicaid
NJ021521Medicare PIN
PA0017911420001Medicaid