Basic Information
| Provider Information | |||||||||
| NPI: | 1669970075 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DHANIRAM | ||||||||
| FirstName: | DAIRANIE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10518 134TH ST | ||||||||
| Address2: | |||||||||
| City: | SOUTH RICHMOND HILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114193210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7183007158 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7925 WINCHESTER BLVD | ||||||||
| Address2: | |||||||||
| City: | QUEENS VILLAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114272128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184647500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2018 | ||||||||
| LastUpdateDate: | 01/31/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0809X | 689476 | NY | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Adult |
No ID Information.