Provider Demographics
NPI:1144716374
Name:ORTHOPEDIC SURGERY AND SPORTS MEDICINE OF NEW YORK, PLLC
Entity type:Organization
Organization Name:ORTHOPEDIC SURGERY AND SPORTS MEDICINE OF NEW YORK, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:VISHAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:914-369-1700
Mailing Address - Street 1:1088 N BROADWAY FL 1
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1107
Mailing Address - Country:US
Mailing Address - Phone:917-727-7646
Mailing Address - Fax:
Practice Address - Street 1:984 N BROADWAY STE 306
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-1308
Practice Address - Country:US
Practice Address - Phone:917-727-7646
Practice Address - Fax:914-612-7883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-11
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPENDINGMedicaid