MEDICARE: DR. JATIN MAHESH VYAS MD,PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0200X	Infectious Disease Physician	333389	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	157272	OTHER	MA	TUFTS HEALTH PLAN
3	J22336	OTHER	MA	BCBS MA

General Provider Information

NPI Number	:	1467442541
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JATIN MAHESH VYAS MD,PHD

Provider Business Mailing Address
First Line	:	180 FORT WASHINGTON AVE FL 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3722
Country	:	US
Telephone Number	:	212-305-8039
Fax Number	:	212-305-1754

Provider Business Practice Location Address
First Line	:	180 FORT WASHINGTON AVE FL 2
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3722
Country	:	US
Telephone Number	:	212-305-8039
Fax Number	:	212-305-1754

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	10/25/2024

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