Basic Information
| Provider Information | |||||||||
| NPI: | 1033252036 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SANDEEP VIJAY MD LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2251 N RAMPART BLVD | ||||||||
| Address2: | SUITE 127 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891287640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7023881300 | ||||||||
| FaxNumber: | 7022545631 | ||||||||
| Practice Location | |||||||||
| Address1: | 2251 N RAMPART BLVD | ||||||||
| Address2: | SUITE 127 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891287640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022563637 | ||||||||
| FaxNumber: | 7022545631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2007 | ||||||||
| LastUpdateDate: | 02/26/2021 | ||||||||
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| AuthorizedOfficialLastName: | VIJAY | ||||||||
| AuthorizedOfficialFirstName: | SANDEEP | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7022563637 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 02/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1538202536 | 01 | NPI INDIVIDUAL | OTHER | 1033252036 | 01 | NPI GROUP | OTHER |