Provider Demographics
NPI:1467442541
Name:VYAS, JATIN MAHESH (MD,PHD)
Entity type:Individual
Prefix:DR
First Name:JATIN
Middle Name:MAHESH
Last Name:VYAS
Suffix:
Gender:M
Credentials:MD,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 FORT WASHINGTON AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-3722
Mailing Address - Country:US
Mailing Address - Phone:212-305-8039
Mailing Address - Fax:212-305-1754
Practice Address - Street 1:180 FORT WASHINGTON AVE FL 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3722
Practice Address - Country:US
Practice Address - Phone:212-305-8039
Practice Address - Fax:212-305-1754
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY333389207RI0200X
MA157272207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3208214Medicaid
MA157272OtherTUFTS HEALTH PLAN
MAJ22336OtherBCBS MA
MAA29819Medicare ID - Type Unspecified
MA3208214Medicaid