Basic Information
| Provider Information | |||||||||
| NPI: | 1376542753 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NIGAM | ||||||||
| FirstName: | VINOD | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 ELMWOOD AVE | ||||||||
| Address2: | PO BOX 648 | ||||||||
| City: | ROCHESTER | ||||||||
| State: | NY | ||||||||
| PostalCode: | 146428648 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5852752734 | ||||||||
| FaxNumber: | 5852731033 | ||||||||
| Practice Location | |||||||||
| Address1: | 1150 YOUNGS RD | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | WILLIAMSVILLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 142218053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166887622 | ||||||||
| FaxNumber: | 7166887592 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2005 | ||||||||
| LastUpdateDate: | 08/21/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085N0904X | 206349 | NY | N | Allopathic & Osteopathic Physicians | Radiology | Nuclear Radiology | 2085R0202X | 206349 | NY | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 00040941407 | 01 | NY | UNIVERA/EXCELLUS # | OTHER | 5609957 | 01 | NY | INDEPENDENT HEALTH # | OTHER | CR-DRA206349-3W | 01 | NY | WORKERS COMPENSATION # | OTHER | 01748190 | 05 | NY | MEDICAID | 300137047 | 01 | NY | RAIL ROAD MEDICARE | OTHER | 000525006020 | 01 | NY | BLUE CROSS WNY # | OTHER | 150590FF | 01 | NY | PREFERRED CARE-ROCHESTER | OTHER |