Provider Demographics
NPI:1952015695
Name:JOHAR, VIKAS
Entity Type:Individual
Prefix:MR
First Name:VIKAS
Middle Name:
Last Name:JOHAR
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 1:2007 EVERETT ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2345
Mailing Address - Country:US
Mailing Address - Phone:929-519-1748
Mailing Address - Fax:
Practice Address - Street 1:2007 EVERETT ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2345
Practice Address - Country:US
Practice Address - Phone:929-519-1748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY915386477Medicaid