Healthcare Provider Details

I. General information

NPI: 1245140235
Provider Name (Legal Business Name): VIKRUM KOONER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 S FULTON AVE
MOUNT VERNON NY
10553-1765
US

IV. Provider business mailing address

444 S FULTON AVE
MOUNT VERNON NY
10553-1765
US

V. Phone/Fax

Practice location:
  • Phone: 914-407-3686
  • Fax:
Mailing address:
  • Phone: 914-407-3686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number056179
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: