Healthcare Provider Details

I. General information

NPI: 1720718505
Provider Name (Legal Business Name): NILESH BHARGAV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 MAIN ST
NEW PALTZ NY
12561-1623
US

IV. Provider business mailing address

396 BROADWAY
KINGSTON NY
12401-4626
US

V. Phone/Fax

Practice location:
  • Phone: 845-255-2930
  • Fax: 845-255-3089
Mailing address:
  • Phone: 845-802-7600
  • Fax: 845-338-0307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025-02899
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: