Healthcare Provider Details

I. General information

NPI: 1407427958
Provider Name (Legal Business Name): VIDISHA SAURABH MASTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 W 23RD ST FL 2
NEW YORK NY
10011-2202
US

IV. Provider business mailing address

309 W 23RD ST FL 2
NEW YORK NY
10011-2202
US

V. Phone/Fax

Practice location:
  • Phone: 212-256-7000
  • Fax:
Mailing address:
  • Phone: 212-256-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number343233
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: