Provider Demographics
NPI:1558358200
Name:JUTHANI, VIRENDRA J (MD)
Entity Type:Individual
Prefix:
First Name:VIRENDRA
Middle Name:J
Last Name:JUTHANI
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 1:17 PHEASANT RUN
Mailing Address - Street 2:
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-3100
Mailing Address - Country:US
Mailing Address - Phone:914-713-4964
Mailing Address - Fax:914-723-2475
Practice Address - Street 1:17 PHEASANT RUN
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-3100
Practice Address - Country:US
Practice Address - Phone:914-713-4964
Practice Address - Fax:914-723-2475
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-28
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115176207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00211743Medicaid
NY507941Medicare ID - Type Unspecified
NY00211743Medicaid