Provider Demographics
NPI:1083828412
Name:VISTA MEDICAL P.C.
Entity Type:Organization
Organization Name:VISTA MEDICAL P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VASANT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHHEDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-487-5858
Mailing Address - Street 1:307 E SHORE RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2420
Mailing Address - Country:US
Mailing Address - Phone:516-487-5858
Mailing Address - Fax:
Practice Address - Street 1:307 E SHORE RD
Practice Address - Street 2:2ND FLOOR
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2420
Practice Address - Country:US
Practice Address - Phone:516-487-5858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty