Healthcare Provider Details

I. General information

NPI: 1053061614
Provider Name (Legal Business Name): VIKAS KANNEGANTI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2022
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 FORT WASHINGTON AVE
NEW YORK NY
10032-3722
US

IV. Provider business mailing address

1320 YORK AVE APT 26M
NEW YORK NY
10021-4868
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-8592
  • Fax:
Mailing address:
  • Phone: 734-709-6057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: