1942590021 NPI number — VINOD PRADEEPKUMAR MITTA M.D., M.P.H.

Table of content: VINOD PRADEEPKUMAR MITTA M.D., M.P.H. (NPI 1942590021)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942590021 NPI number — VINOD PRADEEPKUMAR MITTA M.D., M.P.H.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITTA
Provider First Name:
VINOD
Provider Middle Name:
PRADEEPKUMAR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D., M.P.H.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942590021
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2093 PHILADELPHIA PIKE # 8384
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLAYMONT
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19703-2424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 GREENWICH ST FL 29
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW YORK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10007-2381
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-227-5687
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2083P0901X , with the licence number:  276469 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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