Healthcare Provider Details

I. General information

NPI: 1083672463
Provider Name (Legal Business Name): VIVEK Y REDDY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 E 98TH ST 3RD FLOOR
NEW YORK NY
10029-6501
US

IV. Provider business mailing address

1 GUSTAVE L LEVY PL BOX 1030
NEW YORK NY
10029-6500
US

V. Phone/Fax

Practice location:
  • Phone: 212-427-1540
  • Fax: 212-876-1493
Mailing address:
  • Phone: 212-241-7114
  • Fax: 212-241-8872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number253476
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number253476
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: