Individual
SHIRISH THANAWALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3117 BUHRE AVE, BRONX, NY 10461-4738
(718) 828-1148
Mailing address
3117 BUHRE AVE, BRONX, NY 10461-4738
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
NY125316
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0010009
GHI
NY
05
—
00562809
—
NY
01
—
87B281
BCBS
NY
01
—
P00242609
RR MCR
—
Enumeration date
08/14/2006
Last updated
07/08/2007
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