Basic Information
Provider Information | |||||||||
NPI: | 1588971279 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VYAS | ||||||||
FirstName: | ANAND | ||||||||
MiddleName: | R | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | PT | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 13876 QUEENS BLVD FL 1 | ||||||||
Address2: |   | ||||||||
City: | BRIARWOOD | ||||||||
State: | NY | ||||||||
PostalCode: | 114352930 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7188506345 | ||||||||
FaxNumber: | 7185594895 | ||||||||
Practice Location | |||||||||
Address1: | 138-76 QUEENS BLVD 1ST FLOOR | ||||||||
Address2: |   | ||||||||
City: | BRIARWOOD | ||||||||
State: | NY | ||||||||
PostalCode: | 114352930 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7188506345 | ||||||||
FaxNumber: | 7185594895 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/02/2010 | ||||||||
LastUpdateDate: | 09/02/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NR0400X | P77489 | NY | Y | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | Rehabilitation |
ID Information
ID | Type | State | Issuer | Description | 261665877 | 01 | NY | PHYSICAL THERAPY | OTHER |