MEDICARE: DR. VIJAY KHATIWALA M.D.

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	207R00000X	Internal Medicine Physician	193352	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

General Provider Information

NPI Number	:	1831160589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIJAY KHATIWALA M.D.

Provider Business Mailing Address
First Line	:	640 E 233RD ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2802
Country	:	US
Telephone Number	:	718-325-3500
Fax Number	:	718-325-4655

Provider Business Practice Location Address
First Line	:	640 E 233RD ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10466-2802
Country	:	US
Telephone Number	:	718-325-3500
Fax Number	:	718-325-4655

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

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	07/16/2015

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