Healthcare Provider Details

I. General information

NPI: 1740505296
Provider Name (Legal Business Name): VIKRAM BHASIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2010
Last Update Date: 10/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 E 210TH ST
BRONX NY
10467
US

IV. Provider business mailing address

111 E 210TH ST
BRONX NY
10467-2401
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-6423
  • Fax: 718-881-2245
Mailing address:
  • Phone: 718-920-6423
  • Fax: 718-881-2245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number289046-1
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberNONE
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: