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General NPI Number Information
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NPI Number | 1356169619
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Entity Type | Organization
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Legal Business Name | FRUITION MEDICINE PLLC
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Dates
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Enumeration Date | 09/26/2024
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Last Update Date | 11/29/2024
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Provider Practice Location Address
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Address Line | 2418 E YORK ST
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City | PHILADELPHIA
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State | PA
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Zip | 19125-3006
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Country | US
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Telephone | 267-360-7927
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Fax | 215-267-9781
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Provider Business Mailing Address
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Address Line | 2418 E YORK ST
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City | PHILADELPHIA
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State | PA
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Zip | 19125-3006
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Country | US
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Telephone | 267-360-7927
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Fax | 215-267-9781
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Authorized Official
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Title or Position | FOUNDER/PHYSICIAN
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Name | DR. ASHVIN VIJAYAKUMAR
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Credential | MD
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Telephone | 267-360-7927
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QC1800X
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Taxonomy Name | Corporate Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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