Healthcare Provider Details

I. General information

NPI: 1215963855
Provider Name (Legal Business Name): HEMA DALAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 04/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 W MONTAUK HWY BLDG B , SUITE F
HAMPTON BAYS NY
11946-2345
US

IV. Provider business mailing address

182 W MONTAUK HWY STE B
HAMPTON BAYS NY
11946-4210
US

V. Phone/Fax

Practice location:
  • Phone: 631-728-9391
  • Fax: 631-723-7004
Mailing address:
  • Phone: 631-728-9391
  • Fax: 631-723-7004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number199984
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: