Basic Information
| Provider Information | |||||||||
| NPI: | 1790774529 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VYAVAHARKAR | ||||||||
| FirstName: | PURNIMA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2001 | ||||||||
| Address2: | |||||||||
| City: | EAST SYRACUSE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130574501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3154492208 | ||||||||
| FaxNumber: | 3153625120 | ||||||||
| Practice Location | |||||||||
| Address1: | 8400 OSWEGO RD | ||||||||
| Address2: | |||||||||
| City: | LIVERPOOL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 130901004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3156527939 | ||||||||
| FaxNumber: | 3156526331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 161332 | NY | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.