MEDICARE: DR. BHUPENDRA MANILAL TOLIA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	111622	NY

General Provider Information

NPI Number	:	1508866567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BHUPENDRA MANILAL TOLIA M.D.

Provider Business Mailing Address
First Line	:	1500 ROUTE 112 BLDG 4
Second Line	:
City	:	PORT JEFFERSON STATION
State	:	NY
Zip	:	11776-8055
Country	:	US
Telephone Number	:	631-751-3000
Fax Number	:	631-509-6559

Provider Business Practice Location Address
First Line	:	2426 EASTCHESTER RD
Second Line	:	STE 212
City	:	BRONX
State	:	NY
Zip	:	10469-5950
Country	:	US
Telephone Number	:	718-228-0063
Fax Number	:	718-228-0066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	01/31/2020

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