Basic Information
| Provider Information | |||||||||
| NPI: | 1558357558 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VASUDEVAN | ||||||||
| FirstName: | VISWANATH | ||||||||
| MiddleName: | PARAMESWAR | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13 TURF LN | ||||||||
| Address2: | |||||||||
| City: | ROSLYN HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115772713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164842160 | ||||||||
| FaxNumber: | 5164845681 | ||||||||
| Practice Location | |||||||||
| Address1: | 13 TURF LN | ||||||||
| Address2: | |||||||||
| City: | ROSLYN HEIGHTS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115772713 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164842160 | ||||||||
| FaxNumber: | 5164845681 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2005 | ||||||||
| LastUpdateDate: | 08/15/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 142946 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01299256 | 05 | NY | MEDICAID |