MEDICARE: DR. GURPAL SINGH DHANJAL MD

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1720509623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GURPAL SINGH DHANJAL MD

Provider Business Mailing Address
First Line	:	2061 UNION BLVD APT 1D
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8036
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2061 UNION BLVD APT 1D
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8036
Country	:	US
Telephone Number	:	631-968-3000
Fax Number	:

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

Provider Enumeration Date	:	06/29/2017
Last Update Date	:	06/29/2017

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