Basic Information
| Provider Information | |||||||||
| NPI: | 1508094814 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GARG | ||||||||
| FirstName: | VIVEK | ||||||||
| MiddleName: | KUMAR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 E 89TH ST | ||||||||
| Address2: | APT 14B | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 101286763 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 408 W 14TH ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100141042 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125300639 | ||||||||
| FaxNumber: | 2128674353 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2009 | ||||||||
| LastUpdateDate: | 12/07/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 266401 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 252505 | MA | N | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.