Provider Demographics
NPI:1396755955
Name:BHAGAT, VINOD GOPAL (MD)
Entity type:Individual
Prefix:
First Name:VINOD
Middle Name:GOPAL
Last Name:BHAGAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2255 ADAM CLAYTON POWELL JR BLVD # 2257
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-7807
Mailing Address - Country:US
Mailing Address - Phone:212-281-5252
Mailing Address - Fax:212-348-5194
Practice Address - Street 1:2255 ADAM CLAYTON POWELL JR BLVD # 2257
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10027-7807
Practice Address - Country:US
Practice Address - Phone:212-289-5795
Practice Address - Fax:212-348-5194
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY261329207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY12221WP501OtherMEDICARE
NY03340654Medicaid