Healthcare Provider Details

I. General information

NPI: 1407179740
Provider Name (Legal Business Name): ISSAI VANAN MD,MPH,FAAP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2010
Last Update Date: 03/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

269-01 76TH AVE
NEW HYDE PARK NY
11040
US

IV. Provider business mailing address

269-01 76TH AVE
NEW HYDE PARK NY
11040
US

V. Phone/Fax

Practice location:
  • Phone: 917-620-6946
  • Fax: 718-343-4642
Mailing address:
  • Phone: 917-620-6946
  • Fax: 718-343-4642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberP74362
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: