Basic Information
Provider Information
NPI: 1396791000
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BHORA
FirstName: FAIZ
MiddleName: Y
NamePrefix:  
NameSuffix:  
Credential: M.D.,
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Mailing Information
Address1: 1351 ROUTE 55 STE 200
Address2:  
City: LAGRANGEVILLE
State: NY
PostalCode: 125405128
CountryCode: US
TelephoneNumber: 8454759661
FaxNumber: 8454759938
Practice Location
Address1: 45 READE PLACE
Address2: DYSON CENTER 3RD FLOOR
City: POUGHKEEPSIE
State: NY
PostalCode: 12601
CountryCode: US
TelephoneNumber: 8454836920
FaxNumber: 8454836922
Other Information
ProviderEnumerationDate: 05/25/2006
LastUpdateDate: 09/27/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208600000X002576NYN Allopathic & Osteopathic PhysiciansSurgery 
208G00000X63792CTN Allopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery) 
208G00000X261372NYY Allopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery) 

No ID Information.


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