=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821535170
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLUSHOT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/25/2017
-----------------------------------------------------
Last Update Date | 01/25/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 PROSPECT AVE BUILDING 2-2F
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06850-3737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-234-2108
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 40 PROSPECT AVE BUILDING 2-2F
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06850-3737
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-234-2108
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | DR. ADITI VYAS
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 630-234-2108
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2083X0100X
-----------------------------------------------------
Taxonomy Name | Occupational Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------