Provider Demographics
NPI:1902267529
Name:BANDHU, VISHWANAUTH
Entity Type:Individual
Prefix:
First Name:VISHWANAUTH
Middle Name:
Last Name:BANDHU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8988 219TH ST
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2516
Mailing Address - Country:US
Mailing Address - Phone:212-470-1352
Mailing Address - Fax:
Practice Address - Street 1:8988 219TH ST
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11427-2516
Practice Address - Country:US
Practice Address - Phone:212-470-1352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)