Healthcare Provider Details

I. General information

NPI: 1356169619
Provider Name (Legal Business Name): FRUITION MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2024
Last Update Date: 11/29/2024
Certification Date: 11/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2418 E YORK ST
PHILADELPHIA PA
19125-3006
US

IV. Provider business mailing address

2418 E YORK ST
PHILADELPHIA PA
19125-3006
US

V. Phone/Fax

Practice location:
  • Phone: 267-360-7927
  • Fax: 215-267-9781
Mailing address:
  • Phone: 267-360-7927
  • Fax: 215-267-9781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHVIN VIJAYAKUMAR
Title or Position: FOUNDER/PHYSICIAN
Credential: MD
Phone: 267-360-7927