Provider Demographics
NPI:1114144235
Name:VIDYARTHI, VASUNDHARA
Entity Type:Individual
Prefix:DR
First Name:VASUNDHARA
Middle Name:
Last Name:VIDYARTHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 PINE DR
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-2838
Mailing Address - Country:US
Mailing Address - Phone:847-840-5158
Mailing Address - Fax:516-365-0729
Practice Address - Street 1:22 PINE DR
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2838
Practice Address - Country:US
Practice Address - Phone:847-840-5158
Practice Address - Fax:516-365-0729
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY257109207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease