Provider Demographics
NPI:1720021108
Name:AGGARWAL, VINAY RAJKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:VINAY
Middle Name:RAJKUMAR
Last Name:AGGARWAL
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 1:80 WEST AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-1322
Mailing Address - Country:US
Mailing Address - Phone:585-637-9510
Mailing Address - Fax:585-637-9512
Practice Address - Street 1:80 WEST AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-1322
Practice Address - Country:US
Practice Address - Phone:585-637-9510
Practice Address - Fax:585-637-9512
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY203697-1207Q00000X
NY203697207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01808882Medicaid
000915049008OtherBC/BS
G67749Medicare UPIN
NYRB0225Medicare PIN
000915049008OtherBC/BS
NY01808882Medicaid