1205520079 NPI number — FNU N/A VISHAL

Table of content: FNU N/A VISHAL (NPI 1205520079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205520079 NPI number — FNU N/A VISHAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VISHAL
Provider First Name:
FNU
Provider Middle Name:
N/A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205520079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
NORTON IM RESIDENCY CLINIC
Provider Second Line Business Mailing Address:
96 15TH STREET.NW, SUIT 111
Provider Business Mailing Address City Name:
NORTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24273
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-439-1872
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 KINGS HWY S STE 2525
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCHESTER
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14617-5504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
58-592-2400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2023

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 390200000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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