Provider Demographics
NPI:1215013032
Name:REDDY, VIJAYA K (MD)
Entity Type:Individual
Prefix:
First Name:VIJAYA
Middle Name:K
Last Name:REDDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DOBBSFERRY
Mailing Address - State:NY
Mailing Address - Zip Code:10522
Mailing Address - Country:US
Mailing Address - Phone:914-693-0782
Mailing Address - Fax:914-693-0782
Practice Address - Street 1:45 RIDGE RD
Practice Address - Street 2:
Practice Address - City:DOBBS FERRY
Practice Address - State:NY
Practice Address - Zip Code:10522-3300
Practice Address - Country:US
Practice Address - Phone:914-693-0782
Practice Address - Fax:914-693-0782
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY123711-1207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY23K521Medicare ID - Type Unspecified
NYF22156Medicare UPIN