Provider Demographics
NPI:1205919115
Name:SEODAT, VISHNUDAT (MD)
Entity type:Individual
Prefix:
First Name:VISHNUDAT
Middle Name:
Last Name:SEODAT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 OLD COUNTRY RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2121
Mailing Address - Country:US
Mailing Address - Phone:631-298-4479
Mailing Address - Fax:631-591-3047
Practice Address - Street 1:31 MAIN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-1953
Practice Address - Country:US
Practice Address - Phone:631-722-4400
Practice Address - Fax:631-722-4426
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY174744-1207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01104181Medicaid
NYD92243Medicare UPIN
NY00F312Medicare ID - Type Unspecified