Healthcare Provider Details

I. General information

NPI: 1457665572
Provider Name (Legal Business Name): NYSHA VIRJI O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2010
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W 42ND ST
NEW YORK NY
10036-8005
US

IV. Provider business mailing address

4 DENNETT PL APT 2R
BROOKLYN NY
11231-4503
US

V. Phone/Fax

Practice location:
  • Phone: 312-833-9805
  • Fax:
Mailing address:
  • Phone: 312-833-9805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number007621
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: