Healthcare Provider Details

I. General information

NPI: 1942590021
Provider Name (Legal Business Name): VINOD PRADEEPKUMAR MITTA M.D., M.P.H.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 GREENWICH ST FL 29
NEW YORK NY
10007-2381
US

IV. Provider business mailing address

2093 PHILADELPHIA PIKE # 8384
CLAYMONT DE
19703-2424
US

V. Phone/Fax

Practice location:
  • Phone: 310-227-5687
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number276469
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: