1609239623 NPI number — VIN SIVAN PILLAI M.D.

Table of content: VIN SIVAN PILLAI M.D. (NPI 1609239623)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609239623 NPI number — VIN SIVAN PILLAI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PILLAI
Provider First Name:
VIN
Provider Middle Name:
SIVAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PILLAI
Provider Other First Name:
VINAYAK
Provider Other Middle Name:
SIVAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1609239623
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1290 SILAS DEANE HWY FL 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WETHERSFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06109-4337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-972-6970
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SUNY DOWNSTATE MEDICAL CENTER
Provider Second Line Business Practice Location Address:
450 CLARKSON AVENUE
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-270-1662
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  64806 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 64806 . This is a "CT LICENSE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".