Basic Information
Provider Information | |||||||||
NPI: | 1912226416 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | VADADA | ||||||||
FirstName: | AMITA | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 55 WATER STREET | ||||||||
Address2: | 2ND FLOOR CRED DEPT | ||||||||
City: | NEW YORK | ||||||||
State: | NY | ||||||||
PostalCode: | 100410004 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6466802888 | ||||||||
FaxNumber: | 5165425556 | ||||||||
Practice Location | |||||||||
Address1: | 21 E 22ND ST | ||||||||
Address2: |   | ||||||||
City: | NEW YORK | ||||||||
State: | NY | ||||||||
PostalCode: | 100109995 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2124607800 | ||||||||
FaxNumber: | 2124607877 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/24/2010 | ||||||||
LastUpdateDate: | 10/01/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 25MA08742400 | NJ | N |   | Allopathic & Osteopathic Physicians | Ophthalmology |   | 207W00000X | 261631 | NY | Y |   | Allopathic & Osteopathic Physicians | Ophthalmology |   |
ID Information
ID | Type | State | Issuer | Description | 03366929 | 05 | NY |   | MEDICAID |