Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 113418 | NY |
NPI | 1053759241 |
---|---|
Provider Name | Dr. Bhagwan W Gajwani |
First Address | Vestal, NY 13850-3260 |
Second Address | Vestal, NY 13850-3260 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2013 |
Last Update Date | 10/06/2013 |