Healthcare Provider Details

I. General information

NPI: 1548751332
Provider Name (Legal Business Name): AASHAY VYAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2018
Last Update Date: 10/12/2022
Certification Date: 10/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E MAIN ST
MOUNT KISCO NY
10549-3417
US

IV. Provider business mailing address

800 E 55TH ST
CHICAGO IL
60615-4906
US

V. Phone/Fax

Practice location:
  • Phone: 914-666-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number319358
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036.156556
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: