Provider Demographics
NPI:1619132636
Name:ARIYARAJAH, VIGNENDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:VIGNENDRA
Middle Name:
Last Name:ARIYARAJAH
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 1:829 WASHINGTON STREET
Mailing Address - Street 2:PHD 4
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4101
Mailing Address - Country:US
Mailing Address - Phone:267-694-7608
Mailing Address - Fax:813-329-0146
Practice Address - Street 1:228 MONTROSE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11206-2722
Practice Address - Country:US
Practice Address - Phone:718-284-7070
Practice Address - Fax:813-329-0146
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268773207RC0000X
NY61 003746‏174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03366630Medicaid