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General NPI Number Information
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NPI Number | 1598901720
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Entity Type | Organization
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Legal Business Name | DILIP M THAKKER PHYSICIAN PC
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Dates
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Enumeration Date | 12/17/2008
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Last Update Date | 12/17/2008
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Provider Practice Location Address
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Address Line | 10 E 9TH AVE
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City | GLOVERSVILLE
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State | NY
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Zip | 12078-1629
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Country | US
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Telephone | 518-725-6868
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Fax | 518-725-6263
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Provider Business Mailing Address
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Address Line | 10 EAST 9 AVE.
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City | GLOVERSVILLE
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State | NY
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Zip | 12078-1629
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Country | US
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Telephone | 518-725-6868
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Fax | 518-725-6263
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Authorized Official
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Title or Position | OWNER
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Name | DR. DILIP M THAKKER
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Credential | MD
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Telephone | 518-725-6868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 186146-1
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License Number State | NY
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