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General NPI Number Information
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NPI Number | 1003092016
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Entity Type | Individual
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Provider Name | ROY MAHESH
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Gender | Male
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Dates
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Enumeration Date | 01/21/2008
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 6032 FRESH POND ROAD
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City | RIDGEWOOD
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State | NY
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Zip | 11385
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Country | US
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Telephone | 718-304-9764
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Fax |
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Provider Business Mailing Address
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Address Line | 6632 FRESH POND RD
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City | RIDGEWOOD
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State | NY
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Zip | 11385-3305
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Country | US
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Telephone | 718-304-9764
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 046165
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License Number State | NY
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