Provider Demographics
NPI:1831274224
Name:JAISWAL, VISHNU N (MD)
Entity type:Individual
Prefix:
First Name:VISHNU
Middle Name:N
Last Name:JAISWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 VISTA CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-1425
Mailing Address - Country:US
Mailing Address - Phone:718-960-1500
Mailing Address - Fax:718-960-1501
Practice Address - Street 1:MMG - GRAND CONCOURSE
Practice Address - Street 2:2532 GRAND CONCOURSE
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458
Practice Address - Country:US
Practice Address - Phone:718-960-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117539208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics