Provider Demographics
NPI:1376030064
Name:WAGASKAR, VINAYAK GORAKHANATH (MD)
Entity Type:Individual
Prefix:
First Name:VINAYAK
Middle Name:GORAKHANATH
Last Name:WAGASKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPT. OF UROLOGY, ICAHN SCHOOL OF MEDICINE MOUNT SINAI
Mailing Address - Street 2:ONE GUSTAVE L. LEVY PLACE; BX -1272
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6574
Mailing Address - Country:US
Mailing Address - Phone:212-241-8711
Mailing Address - Fax:
Practice Address - Street 1:SECOND FLOOR, 625 MADISON AVE.
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022
Practice Address - Country:US
Practice Address - Phone:212-241-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-18
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP09775208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology