Healthcare Provider Details

I. General information

NPI: 1497374359
Provider Name (Legal Business Name): MEDICAL HEALTH 360 PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16955 COUNTY ROUTE 59
DEXTER NY
13634-2027
US

IV. Provider business mailing address

117 GREENWAY W
NEW HYDE PARK NY
11040-2226
US

V. Phone/Fax

Practice location:
  • Phone: 888-860-0507
  • Fax:
Mailing address:
  • Phone: 888-860-0507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

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

# 1
Identifier14442662
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: DR. TATTVAMASI PARIKH
Title or Position: OWNER
Credential: MD
Phone: 516-724-7339