Provider Demographics
NPI:1831361674
Name:DR.SHAKUNTALA J MARKALE
Entity type:Organization
Organization Name:DR.SHAKUNTALA J MARKALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAGDISH
Authorized Official - Middle Name:N
Authorized Official - Last Name:MARKALE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:7185-887-8781
Mailing Address - Street 1:1171 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-8543
Mailing Address - Country:US
Mailing Address - Phone:718-588-7878
Mailing Address - Fax:718-588-2232
Practice Address - Street 1:1171 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8543
Practice Address - Country:US
Practice Address - Phone:718-588-7878
Practice Address - Fax:718-588-2232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY37311122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00743471Medicaid