Provider Demographics
NPI:1750354213
Name:MALHOTRA, VIDYA (MD)
Entity type:Individual
Prefix:DR
First Name:VIDYA
Middle Name:
Last Name:MALHOTRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 HOLLYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-2133
Mailing Address - Country:US
Mailing Address - Phone:201-568-1904
Mailing Address - Fax:
Practice Address - Street 1:380 2ND AVE
Practice Address - Street 2:GRAMERCY MRI
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5615
Practice Address - Country:US
Practice Address - Phone:212-477-8180
Practice Address - Fax:212-477-7907
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2011-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1514252085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01047929Medicaid
NY01047929Medicaid
NY17D431Medicare ID - Type UnspecifiedPROVIDER NUMBER