Provider Demographics
NPI:1831151588
Name:VIG, INDERJITSINGH GURMUKHSINGH (DDS)
Entity type:Individual
Prefix:DR
First Name:INDERJITSINGH
Middle Name:GURMUKHSINGH
Last Name:VIG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 593
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL JUNCTION
Mailing Address - State:NY
Mailing Address - Zip Code:12533
Mailing Address - Country:US
Mailing Address - Phone:845-226-4474
Mailing Address - Fax:845-226-4741
Practice Address - Street 1:135 CLOVE BRANCH ROAD
Practice Address - Street 2:
Practice Address - City:HOPEWELL JUNCTION
Practice Address - State:NY
Practice Address - Zip Code:12533
Practice Address - Country:US
Practice Address - Phone:845-226-4474
Practice Address - Fax:845-226-4741
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035501122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00541653Medicaid