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General NPI Number Information
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NPI Number | 1205808813
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Entity Type | Individual
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Provider Name | THURAIRASAH VIJAYANATHAN MD
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Gender | Male
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Dates
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Enumeration Date | 02/07/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 6416 BERGENLINE AVE
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-1621
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Country | US
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Telephone | 201-295-1099
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Fax | 201-295-1035
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Provider Business Mailing Address
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Address Line | 6416 BERGENLINE AVE
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City | WEST NEW YORK
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State | NJ
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Zip | 07093-1621
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Country | US
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Telephone | 201-295-1099
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Fax | 201-295-1035
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MA26891
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License Number State | NJ
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