Healthcare Provider Details

I. General information

NPI: 1427131010
Provider Name (Legal Business Name): RENUKA RAO BIJOOR DDS MPH MDS FDSRCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 11/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 S HIGHLAND AVE
BRIARCLIFF MANOR NY
10510-2096
US

IV. Provider business mailing address

325 S HIGHLAND AVE
BRIARCLIFF MANOR NY
10510-2096
US

V. Phone/Fax

Practice location:
  • Phone: 914-762-4151
  • Fax: 914-762-4153
Mailing address:
  • Phone: 914-762-4151
  • Fax: 914-762-4153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number051160
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: