Provider Demographics
NPI:1104202118
Name:VENGALIL, BIJI MANOJ (NP)
Entity Type:Individual
Prefix:MRS
First Name:BIJI
Middle Name:MANOJ
Last Name:VENGALIL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 NORTH ST STE 307
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4123
Mailing Address - Country:US
Mailing Address - Phone:413-496-6838
Mailing Address - Fax:413-496-6839
Practice Address - Street 1:165 TOR CT
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-3001
Practice Address - Country:US
Practice Address - Phone:413-447-2701
Practice Address - Fax:413-447-2101
Is Sole Proprietor?:No
Enumeration Date:2015-08-03
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN245714363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily