Healthcare Provider Details

I. General information

NPI: 1417367152
Provider Name (Legal Business Name): VIGNENDRA ARIYARAJAH MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2014
Last Update Date: 05/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 MONTROSE AVE
BROOKLYN NY
11206-2722
US

IV. Provider business mailing address

228 MONTROSE AVE
BROOKLYN NY
11206-2722
US

V. Phone/Fax

Practice location:
  • Phone: 267-694-7608
  • Fax: 813-329-0146
Mailing address:
  • Phone: 267-694-7608
  • Fax: 813-329-0146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number12205390
License Number StateNY

VIII. Authorized Official

Name: DR. VIGNENDRA ARIYARAJAH
Title or Position: M.D.
Credential: M.D
Phone: 267-694-7608