Provider Demographics
NPI:1356169619
Name:FRUITION MEDICINE PLLC
Entity type:Organization
Organization Name:FRUITION MEDICINE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:VIJAYAKUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:267-360-7927
Mailing Address - Street 1:2418 E YORK ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19125-3006
Mailing Address - Country:US
Mailing Address - Phone:267-360-7927
Mailing Address - Fax:215-267-9781
Practice Address - Street 1:2418 E YORK ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125-3006
Practice Address - Country:US
Practice Address - Phone:267-360-7927
Practice Address - Fax:215-267-9781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-26
Last Update Date:2024-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health