MEDICARE: VEIN SPECIALIST OF NEW YORK

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	2086S0129X	Vascular Surgery Physician

General Provider Information

NPI Number	:	1902930142
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VEIN SPECIALIST OF NEW YORK

Provider Business Mailing Address
First Line	:	PO BOX 172
Second Line	:
City	:	LOCUST VALLEY
State	:	NY
Zip	:	11560-0172
Country	:	US
Telephone Number	:	800-353-5420
Fax Number	:	866-897-5366

Provider Business Practice Location Address
First Line	:	50 E 78TH ST
Second Line	:	SUITE 1B
City	:	NEW YORK
State	:	NY
Zip	:	10021-1837
Country	:	US
Telephone Number	:	800-353-5420
Fax Number	:	866-897-5366

Authorized Official
Title or Position	:	PROVIDER
Name	:	AMIYA PRASAD
Credential	:	MD
Telephone Number	:	800-353-5420

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	08/22/2020

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