Healthcare Provider Details

I. General information

NPI: 1821057373
Provider Name (Legal Business Name): HASIT THAKORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13420 JAMAICA AVE
JAMAICA NY
11418-2619
US

IV. Provider business mailing address

80 MARCUS DR
MELVILLE NY
11747-4230
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-6742
  • Fax: 718-206-6905
Mailing address:
  • Phone: 631-391-8366
  • Fax: 631-454-4163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number131606
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: