Provider Demographics
NPI:1669756649
Name:PERUGU, VIJAYA DEEPIKA (MD)
Entity type:Individual
Prefix:
First Name:VIJAYA DEEPIKA
Middle Name:
Last Name:PERUGU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 CAMBRIDGE AVENUE
Mailing Address - Street 2:APARTMENT - 4C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463
Mailing Address - Country:US
Mailing Address - Phone:856-857-8246
Mailing Address - Fax:
Practice Address - Street 1:853 TIFFANY ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-4503
Practice Address - Country:US
Practice Address - Phone:718-860-6169
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-07
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY275936207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine