Provider Demographics
NPI:1558461228
Name:PERSAUD, VISHWAMINTRA (MD,)
Entity Type:Individual
Prefix:
First Name:VISHWAMINTRA
Middle Name:
Last Name:PERSAUD
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 1:308A E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4001
Mailing Address - Country:US
Mailing Address - Phone:212-420-6460
Mailing Address - Fax:
Practice Address - Street 1:308A E 15TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4001
Practice Address - Country:US
Practice Address - Phone:212-420-6460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY207867207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02205163Medicaid
NY02205163Medicaid
062AD1Medicare PIN