=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659616340
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEXT LEVEL DIAGNOSTIC LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2012
-----------------------------------------------------
Last Update Date | 12/06/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 257 S MIDDLETOWN RD
-----------------------------------------------------
City | NANUET
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10954-3360
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-623-8000
-----------------------------------------------------
Fax | 845-623-0770
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 358 5TH AVE SUITE 307
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10001-2209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-730-8172
-----------------------------------------------------
Fax | 212-730-8173
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DEEPAK VASISHTHA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 917-968-0730
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 2312232
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------