Provider Demographics
NPI:1427095223
Name:VIDYA VALADA INTERNAL MEDICINE P.C
Entity type:Organization
Organization Name:VIDYA VALADA INTERNAL MEDICINE P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIDYA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD;
Authorized Official - Phone:347-351-3315
Mailing Address - Street 1:35 SUTTON PL # 12D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-2429
Mailing Address - Country:US
Mailing Address - Phone:347-351-3315
Mailing Address - Fax:212-755-0110
Practice Address - Street 1:580 PARK AVE APT 1B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-7342
Practice Address - Country:US
Practice Address - Phone:212-755-0037
Practice Address - Fax:212-688-2207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWJW251Medicare PIN