Provider Demographics
NPI:1982981817
Name:KETAN D VORA DO PC
Entity type:Organization
Organization Name:KETAN D VORA DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KETAN
Authorized Official - Middle Name:DHRUVKUMAR
Authorized Official - Last Name:VORA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:516-220-8960
Mailing Address - Street 1:2801 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11210-2401
Mailing Address - Country:US
Mailing Address - Phone:347-770-9433
Mailing Address - Fax:347-915-0600
Practice Address - Street 1:2801 GLENWOOD RD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-2401
Practice Address - Country:US
Practice Address - Phone:347-770-9433
Practice Address - Fax:347-915-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-06
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243182208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty