Provider Demographics
NPI:1922104330
Name:ADI, VIJAY K (MD)
Entity Type:Individual
Prefix:
First Name:VIJAY
Middle Name:K
Last Name:ADI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:124 COMANCHE TRL
Mailing Address - Street 2:
Mailing Address - City:NISKAYUNA
Mailing Address - State:NY
Mailing Address - Zip Code:12309-2243
Mailing Address - Country:US
Mailing Address - Phone:518-346-6577
Mailing Address - Fax:518-627-0628
Practice Address - Street 1:2614 RIVERFRONT CENTER
Practice Address - Street 2:
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-4819
Practice Address - Country:US
Practice Address - Phone:518-627-0627
Practice Address - Fax:518-627-0628
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2012-02-29
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Provider Licenses
StateLicense IDTaxonomies
NY2237352080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01787351Medicaid