Provider Demographics
NPI:1326383910
Name:DEEPAK VASISHTHA PHYSICIAN PC
Entity Type:Organization
Organization Name:DEEPAK VASISHTHA PHYSICIAN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:
Authorized Official - Last Name:VASISHTHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-310-3350
Mailing Address - Street 1:544 PARK AVE
Mailing Address - Street 2:600
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-1600
Mailing Address - Country:US
Mailing Address - Phone:718-310-3350
Mailing Address - Fax:718-228-9317
Practice Address - Street 1:209 BEACH 125TH ST
Practice Address - Street 2:
Practice Address - City:BELLE HARBOR
Practice Address - State:NY
Practice Address - Zip Code:11694-1703
Practice Address - Country:US
Practice Address - Phone:718-310-3350
Practice Address - Fax:718-228-9317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty