Basic Information
| Provider Information | |||||||||
| NPI: | 1558398271 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ARYA | ||||||||
| FirstName: | YASHPAL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 129 SAINT NICHOLAS AVE | ||||||||
| Address2: | 1F | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112374039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188210643 | ||||||||
| FaxNumber: | 7186284123 | ||||||||
| Practice Location | |||||||||
| Address1: | 129 SAINT NICHOLAS AVE | ||||||||
| Address2: | 1F | ||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112374039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7188210643 | ||||||||
| FaxNumber: | 7186284123 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 12/15/2011 | ||||||||
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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 | 207RG0100X | 114955 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 00210779 | 05 | NY | MEDICAID |