Healthcare Provider Details

I. General information

NPI: 1679750160
Provider Name (Legal Business Name): VINIT KHANNA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2008
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD
PHILADELPHIA PA
19141-3018
US

IV. Provider business mailing address

601 ELMWOOD AVE P.O. BOX 648
ROCHESTER NY
14642-8648
US

V. Phone/Fax

Practice location:
  • Phone: 973-641-3427
  • Fax:
Mailing address:
  • Phone: 585-275-1381
  • Fax: 585-273-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD462609
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number272064
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: