Healthcare Provider Details

I. General information

NPI: 1205194941
Provider Name (Legal Business Name): KARTHIKEYAN MOHANRAM ARCOT M.B.B.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2012
Last Update Date: 08/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 61 STREET 1ST FLOOR
BROOKLYN NY
11220
US

IV. Provider business mailing address

43 WESTMINSTER AVENUE
BERGENFIELD NJ
07621
US

V. Phone/Fax

Practice location:
  • Phone: 718-630-1270
  • Fax: 201-351-0656
Mailing address:
  • Phone: 201-387-1957
  • Fax: 201-387-1036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number25MA09133300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number25MA09133300
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number272080-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License Number272080-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: