=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811956782
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RENU D. PARIKH, MD, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/20/2006
-----------------------------------------------------
Last Update Date | 03/21/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 800 MANOR RD STE 7
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10314-7030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-877-9062
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 140458
-----------------------------------------------------
City | STATEN ISLAND
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10314-0458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-877-9062
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. RENU D PARIKH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 718-877-9062
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 159332
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------