Healthcare Provider Details

I. General information

NPI: 1427831197
Provider Name (Legal Business Name): VISAVIS HEALTH CARE MEDICAL GROUP OF KY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1381 CAMPBELL LN
BOWLING GREEN KY
42104-1049
US

IV. Provider business mailing address

831 BEDFORD AVE STE 530
BROOKLYN NY
11205-2801
US

V. Phone/Fax

Practice location:
  • Phone: 929-491-7333
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: REKHA BHANDARI
Title or Position: OWNER
Credential:
Phone: 212-734-6621