Provider Demographics
NPI:1609594118
Name:VYAS, MOHIT JIGNESHKUMAR
Entity Type:Individual
Prefix:
First Name:MOHIT JIGNESHKUMAR
Middle Name:
Last Name:VYAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 KINGS CANYON WAY
Mailing Address - Street 2:
Mailing Address - City:OAKLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94561-5236
Mailing Address - Country:US
Mailing Address - Phone:341-345-9041
Mailing Address - Fax:
Practice Address - Street 1:31 E 32ND ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5595
Practice Address - Country:US
Practice Address - Phone:212-759-2282
Practice Address - Fax:212-379-2123
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-19
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist