Healthcare Provider Details

I. General information

NPI: 1265622435
Provider Name (Legal Business Name): VIJAY SRICHAND SIDHWANI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 10/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2965 LONG BEACH RD
OCEANSIDE NY
11572-3204
US

IV. Provider business mailing address

14 ERIC LN
NEW HYDE PARK NY
11040-1902
US

V. Phone/Fax

Practice location:
  • Phone: 516-770-8458
  • Fax:
Mailing address:
  • Phone: 516-770-8458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number238259
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: