Healthcare Provider Details

I. General information

NPI: 1255257499
Provider Name (Legal Business Name): VASANT TRAVIS HEERALAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 LAKEVILLE RD STE 225A
NEW HYDE PARK NY
11042-1121
US

IV. Provider business mailing address

13177 228TH ST
LAURELTON NY
11413-1744
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174V00000X
TaxonomyClinical Ethicist
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: