Provider Demographics
NPI:1770745275
Name:MALHOTRA, VIKRUM (MD)
Entity type:Individual
Prefix:DR
First Name:VIKRUM
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:55 WATER ST
Mailing Address - Street 2:CREDENTIALING 12TH FL
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:260 W SUNRISE HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581-1011
Practice Address - Country:US
Practice Address - Phone:516-825-3600
Practice Address - Fax:516-542-5556
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2017-11-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY263202207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY04038157Medicaid
NY04038157Medicaid