=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811973241
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RICHARD DAUHAJRE M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/18/2005
-----------------------------------------------------
Last Update Date | 06/17/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9033 ELMHURST AVE
-----------------------------------------------------
City | JACKSON HEIGHTS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11372-7935
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-457-7000
-----------------------------------------------------
Fax | 718-457-0651
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 80 EAST END AVENUE SUITE 6E
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028-8015
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-644-9320
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208100000X
-----------------------------------------------------
Taxonomy Name | Physical Medicine & Rehabilitation Physician
-----------------------------------------------------
License Number | 219978
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------