Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | AL4088604171 | NY |
NPI | 1003042672 |
---|---|
Provider Name | Deepak Vadada |
First Address | New York, NY 10041-0004 |
Second Address | Staten Island, NY 10301-3627 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2009 |
Last Update Date | 01/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03351342 | (05) | NY |