Basic Information
| Provider Information | |||||||||
| NPI: | 1447749890 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DHILLON | ||||||||
| FirstName: | HARMANDEEP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9A HARRISON AVE | ||||||||
| Address2: | |||||||||
| City: | CARTERET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070081757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3474221290 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1000 MONTAUK HWY | ||||||||
| Address2: | |||||||||
| City: | WEST ISLIP | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117954927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6313764163 | ||||||||
| FaxNumber: | 6313763420 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/01/2018 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 25MB11266100 | NJ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 70553 | CT | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | TPOS341 | FL | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 009588 | AZ | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 91629 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 34.015800 | OH | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | T5868 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 308991 | NY | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.