MEDICARE: VSVL MEDICAL SERVICES LLC

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	207R00000X	Internal Medicine Physician	233520	NY

General Provider Information

NPI Number	:	1932344306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VSVL MEDICAL SERVICES LLC

Provider Business Mailing Address
First Line	:	616 CASTLE HILL AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10473-1402
Country	:	US
Telephone Number	:	718-589-2799
Fax Number	:

Provider Business Practice Location Address
First Line	:	616 CASTLE HILL AVE
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10473-1402
Country	:	US
Telephone Number	:	718-589-2799
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PRASHANTH MANNAM
Credential	:	MD
Telephone Number	:	718-589-2799

Provider Enumeration Date	:	12/12/2008
Last Update Date	:	06/25/2012

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