Healthcare Provider Details

I. General information

NPI: 1497804819
Provider Name (Legal Business Name): DEEPAK VADHAN,MD FCCP,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9920 4TH AVE STE 308
BROOKLYN NY
11209-8331
US

IV. Provider business mailing address

PO BOX 58
ATLANTIC BEACH NY
11509-0058
US

V. Phone/Fax

Practice location:
  • Phone: 718-836-4040
  • Fax: 718-836-4040
Mailing address:
  • Phone: 718-836-4040
  • Fax: 718-836-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier01209934
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name: DEEPAK VADHAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 718-836-4040