Provider Demographics
NPI:1487108387
Name:BOSE PILLAI, MAHUA (DDS, MMSC)
Entity type:Individual
Prefix:DR
First Name:MAHUA
Middle Name:
Last Name:BOSE PILLAI
Suffix:
Gender:F
Credentials:DDS, MMSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 RIVERSIDE BLVD APT 19G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10069-0910
Mailing Address - Country:US
Mailing Address - Phone:631-681-3031
Mailing Address - Fax:
Practice Address - Street 1:30 E 40TH ST RM 506
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-1235
Practice Address - Country:US
Practice Address - Phone:631-681-3031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18573721223E0200X, 1223G0001X
NY060441-011223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice