Healthcare Provider Details

I. General information

NPI: 1588669352
Provider Name (Legal Business Name): MURLIDHAR PAHUJA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4287 RICHMOND AVE
STATEN ISLAND NY
10312-6241
US

IV. Provider business mailing address

4287 RICHMOND AVE
STATEN ISLAND NY
10312-6241
US

V. Phone/Fax

Practice location:
  • Phone: 718-967-6230
  • Fax: 718-356-1992
Mailing address:
  • Phone: 718-967-6230
  • Fax: 718-356-1992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number151762
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: