=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487963120
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIKAS K PILLY MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/29/2010
-----------------------------------------------------
Last Update Date | 09/29/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6245 SHERIDAN DR SUITE 116
-----------------------------------------------------
City | WILLIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221-4834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-505-1500
-----------------------------------------------------
Fax | 888-351-4329
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6245 SHERIDAN DR SUITE 116
-----------------------------------------------------
City | WILLIAMSVILLE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14221-4834
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-505-1500
-----------------------------------------------------
Fax | 888-351-4329
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. VIKAS K PILLY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 716-505-1500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number | 244731
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------