Healthcare Provider Details

I. General information

NPI: 1043147929
Provider Name (Legal Business Name): DRESHAUN BISHOP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 W 232ND ST
BRONX NY
10463-3207
US

IV. Provider business mailing address

640 W 232ND ST
BRONX NY
10463-3207
US

V. Phone/Fax

Practice location:
  • Phone: 718-884-2992
  • Fax: 718-884-2901
Mailing address:
  • Phone: 718-884-2992
  • Fax: 718-884-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: