Provider Demographics
NPI:1780074146
Name:VIGNENDRA ARIYARAJAH MD, PLLC
Entity type:Organization
Organization Name:VIGNENDRA ARIYARAJAH MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:VIGNENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARIYARAJAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-946-5915
Mailing Address - Street 1:845 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4713 CHURCH AVE.
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11203-3209
Practice Address - Country:US
Practice Address - Phone:718-946-5915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-23
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03366630Medicaid