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General NPI Number Information
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NPI Number | 1609925403
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Entity Type | Individual
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Provider Name | VIKASH K MODI MD
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Gender | Male
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Dates
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Enumeration Date | 01/09/2007
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 428 E 72ND ST OFC 100
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City | NEW YORK
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State | NY
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Zip | 10021-4635
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Country | US
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Telephone | 646-962-4780
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Fax |
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Provider Business Mailing Address
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Address Line | 428 E 72ND ST OFC 100
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City | NEW YORK
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State | NY
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Zip | 10021-4635
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Country | US
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Telephone | 646-962-4780
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YP0228X
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Taxonomy Name | Pediatric Otolaryngology Physician
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License Number | 249105
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License Number State | NY
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