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General NPI Number Information
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NPI Number | 1154585347
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Entity Type | Organization
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Legal Business Name | ADIPEDIATRICS
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Dates
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Enumeration Date | 07/16/2008
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Last Update Date | 07/16/2008
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Provider Practice Location Address
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Address Line | 2614 RIVERFRONT CTR
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City | AMSTERDAM
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State | NY
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Zip | 12010-4615
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Country | US
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Telephone | 518-627-0627
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Fax | 518-627-0628
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Provider Business Mailing Address
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Address Line | 124 COMANCHE TRL
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City | NISKAYUNA
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State | NY
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Zip | 12309-2243
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Country | US
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Telephone | 518-627-0627
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Fax | 518-627-0628
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. VIJAY KUMAR ADI
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Credential | MD
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Telephone | 518-627-0627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 223735
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License Number State | NY
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