Provider Demographics
NPI:1407179740
Name:VANAN, ISSAI (MD,MPH,FAAP)
Entity Type:Individual
Prefix:DR
First Name:ISSAI
Middle Name:
Last Name:VANAN
Suffix:
Gender:M
Credentials:MD,MPH,FAAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:269-01 76TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040
Mailing Address - Country:US
Mailing Address - Phone:917-620-6946
Mailing Address - Fax:718-343-4642
Practice Address - Street 1:269-01 76TH AVE
Practice Address - Street 2:
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11040
Practice Address - Country:US
Practice Address - Phone:917-620-6946
Practice Address - Fax:718-343-4642
Is Sole Proprietor?:No
Enumeration Date:2010-03-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP743622080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology