Provider Demographics
NPI:1932354818
Name:VORA, KETAN DHRUVKUMAR (DO)
Entity Type:Individual
Prefix:DR
First Name:KETAN
Middle Name:DHRUVKUMAR
Last Name:VORA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BRADLEY AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4403
Mailing Address - Country:US
Mailing Address - Phone:347-878-2225
Mailing Address - Fax:516-717-3556
Practice Address - Street 1:24 BRADLEY AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-4403
Practice Address - Country:US
Practice Address - Phone:347-878-2225
Practice Address - Fax:516-717-3556
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-19
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2431822081P2900X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine