Healthcare Provider Details

I. General information

NPI: 1588987697
Provider Name (Legal Business Name): ABE JOSEPH VATAKENCHERRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 BROADWAY APT 734
NEW YORK NY
10024-3214
US

IV. Provider business mailing address

2350 BROADWAY APT 734
NEW YORK NY
10024-3214
US

V. Phone/Fax

Practice location:
  • Phone: 917-442-4182
  • Fax:
Mailing address:
  • Phone: 917-442-4182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number250594
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: