Healthcare Provider Details

I. General information

NPI: 1790583490
Provider Name (Legal Business Name): RUJUTA MAYUR BHAVE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

245 NEWTOWN RD STE 102
PLAINVIEW NY
11803-4317
US

IV. Provider business mailing address

245 NEWTOWN RD STE 102
PLAINVIEW NY
11803-4317
US

V. Phone/Fax

Practice location:
  • Phone: 516-802-2518
  • Fax: 516-644-5471
Mailing address:
  • Phone: 516-802-2518
  • Fax: 516-644-5471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number053997
License Number StateNY

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: