Healthcare Provider Details

I. General information

NPI: 1134484462
Provider Name (Legal Business Name): VALMIKI VIJAY SEERAJ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 GRAND CONCOURSE DEPT. OF OB/GYN
BRONX NY
10457-7606
US

IV. Provider business mailing address

1650 GRAND CONCOURSE DEPT. OF OB/GYN
BRONX NY
10457-7606
US

V. Phone/Fax

Practice location:
  • Phone: 718-239-8384
  • Fax:
Mailing address:
  • Phone: 718-239-8384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number301741
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: