Provider Demographics
NPI:1407999394
Name:VIJAY, BOBBY (DMD)
Entity type:Individual
Prefix:DR
First Name:BOBBY
Middle Name:
Last Name:VIJAY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6254 97TH PL
Mailing Address - Street 2:APT 6 I
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1346
Mailing Address - Country:US
Mailing Address - Phone:646-831-5445
Mailing Address - Fax:
Practice Address - Street 1:115 E 61ST ST
Practice Address - Street 2:SUITE 5 E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-8183
Practice Address - Country:US
Practice Address - Phone:212-888-4140
Practice Address - Fax:212-486-7556
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052930122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist