Healthcare Provider Details

I. General information

NPI: 1437484342
Provider Name (Legal Business Name): ANITA BHOLA MEDICAL, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 LAUREL AVE
CORNWALL NY
12518-1403
US

IV. Provider business mailing address

PO BOX 612
MILLWOOD NY
10546-0612
US

V. Phone/Fax

Practice location:
  • Phone: 845-348-2209
  • Fax:
Mailing address:
  • Phone: 845-458-4899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number182716
License Number StateNY

VIII. Authorized Official

Name: ANITA BHOLA
Title or Position: PRESIDENT
Credential: M.D
Phone: 845-458-4899