=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598123317
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NITIN V DOSHI DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/08/2016
-----------------------------------------------------
Last Update Date | 02/08/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24202 61ST AVE
-----------------------------------------------------
City | DOUGLASTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11362-1968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-631-3030
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 560 S BROADWAY
-----------------------------------------------------
City | HICKSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11801-5013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-937-2222
-----------------------------------------------------
Fax | 516-977-1451
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 31373
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------