Provider Demographics
NPI:1578182960
Name:DAVE, PARAM (DO)
Entity type:Individual
Prefix:
First Name:PARAM
Middle Name:
Last Name:DAVE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24818 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:BELLEROSE
Mailing Address - State:NY
Mailing Address - Zip Code:11426-1837
Mailing Address - Country:US
Mailing Address - Phone:516-846-4018
Mailing Address - Fax:
Practice Address - Street 1:24818 UNION TPKE
Practice Address - Street 2:
Practice Address - City:BELLEROSE
Practice Address - State:NY
Practice Address - Zip Code:11426-1837
Practice Address - Country:US
Practice Address - Phone:516-846-4018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT77256207Q00000X
NY319886207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty