=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932271137
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DIPIKA D DOCTOR M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/14/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 98120 QUEENS BLVD
-----------------------------------------------------
City | REGO PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11374-4357
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-275-5800
-----------------------------------------------------
Fax | 718-897-6767
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23 HOFFSTOT LN
-----------------------------------------------------
City | SANDS POINT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11050-1262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-767-0567
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 122257
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------