Basic Information
Provider Information
NPI: 1912174533
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DAVE
FirstName: ANJALEE
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 68 S SERVICE RD STE 350
Address2:  
City: MELVILLE
State: NY
PostalCode: 117472358
CountryCode: US
TelephoneNumber: 5169453000
FaxNumber:  
Practice Location
Address1: 27005 76TH AVE DEPT OF
Address2:  
City: NEW HYDE PARK
State: NY
PostalCode: 110401402
CountryCode: US
TelephoneNumber: 7184704370
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/13/2008
LastUpdateDate: 10/02/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207LP3000X234182NYN Allopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
208000000X234182NYN Allopathic & Osteopathic PhysiciansPediatrics 
207L00000X234182NYY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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