Healthcare Provider Details

I. General information

NPI: 1982900668
Provider Name (Legal Business Name): VADAMALAYAN SIVALINGAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 ATLANTIC AVE DEPT SURGERY
BROOKLYN NY
11213-1122
US

IV. Provider business mailing address

9101 SHORE ROAD APT 114
BROOKLYN NY
11209
US

V. Phone/Fax

Practice location:
  • Phone: 718-613-4084
  • Fax:
Mailing address:
  • Phone: 347-497-5948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number271-022-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: