Basic Information
| Provider Information | |||||||||
| NPI: | 1013084177 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DHALIWAL | ||||||||
| FirstName: | GURPREET | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6255 SHERIDAN DR | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142214836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7168578666 | ||||||||
| FaxNumber: | 7168578944 | ||||||||
| Practice Location | |||||||||
| Address1: | 6245 SHERIDAN DR | ||||||||
| Address2: | |||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142214834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166311150 | ||||||||
| FaxNumber: | 7166301265 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 03/12/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 242343 | NY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 11303 | 01 | NY | MAGNA CARE/AETNA | OTHER | 070807000101 | 01 | NY | FIDELIS | OTHER | 000528954002 | 01 | NY | HEALTH NOW | OTHER | 0714046 | 01 | NY | INDEPENDENT HEALTH | OTHER | 02832837 | 05 | NY | MEDICAID | 00027831001 | 01 | NY | UNIVERA | OTHER |