Individual provider Active NPI

Jayantilal Vallabhbhai Dhaduk, RPH

  • Pharmacist
  • Bronx, NY
National Provider Identifier
1154496925
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
040473 Issued in NY
Practice address
Leroy Pharmacy
358 E 204TH St
Bronx, NY 10467
Phone
(718) 882-5614
Fax
(718) 882-6365
NPI assigned
Nov 21, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 040473 NY Primary

Addresses

Primary practice location

Leroy Pharmacy
358 E 204TH St
Bronx, NY 10467

Mailing address

28 Hudson PL
Bloomfield, NJ 07003-4010
Phone (973) 893-9561

Other identifiers 2

IdentifierTypeStateIssuer
040473OtherNYNY STATE LIC #
01871374MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

State licenses

LicenseStateTypeSpecialty
040473NYMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1154496925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 HUDSON PL",
            "city": "BLOOMFIELD",
            "state": "NJ",
            "postal_code": "070034010",
            "telephone_number": "973-893-9561",
            "fax_number": "718-882-6365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "LEROY PHARMACY",
            "address_2": "358 E 204TH ST",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "10467",
            "telephone_number": "718-882-5614",
            "fax_number": "718-882-6365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DHADUK",
        "first_name": "JAYANTILAL",
        "middle_name": "VALLABHBHAI",
        "name_prefix": "Mr.",
        "credential": "RPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-21",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "040473",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NY STATE LIC #",
            "identifier": "040473",
            "state": "NY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01871374",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bronx, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.