Provider Demographics
NPI:1740713544
Name:ARHIN, VIDA
Entity type:Individual
Prefix:
First Name:VIDA
Middle Name:
Last Name:ARHIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 ALDRICH ST
Mailing Address - Street 2:APARTMENT # 18B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-4502
Mailing Address - Country:US
Mailing Address - Phone:845-800-9305
Mailing Address - Fax:844-800-1470
Practice Address - Street 1:17 N PLANK RD
Practice Address - Street 2:SUITE 10
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-2111
Practice Address - Country:US
Practice Address - Phone:845-800-9305
Practice Address - Fax:844-800-1470
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY338521363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily