MEDICARE: SUBHASH R VISWANATHAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	25MA07825900	NJ
2	207P00000X	Emergency Medicine Physician	248884	NY
3	207P00000X	Emergency Medicine Physician	C149731	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508866542
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUBHASH R VISWANATHAN M.D.

Provider Business Mailing Address
First Line	:	555 N BROADWAY
Second Line	:
City	:	JERICHO
State	:	NY
Zip	:	11753-2134
Country	:	US
Telephone Number	:	516-597-5070
Fax Number	:	516-597-5067

Provider Business Practice Location Address
First Line	:	555 N BROADWAY
Second Line	:
City	:	JERICHO
State	:	NY
Zip	:	11753-2134
Country	:	US
Telephone Number	:	516-597-5070
Fax Number	:	516-597-5067

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	03/08/2024

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