1194785956 NPI number — VIJAY R VASWANI MD

Table of content: VIJAY R VASWANI MD (NPI 1194785956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194785956 NPI number — VIJAY R VASWANI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VASWANI
Provider First Name:
VIJAY
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1194785956
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
30 BRANDYWINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEMBERTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08068-1307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-515-6125
Provider Business Mailing Address Fax Number:
609-400-4888

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 BRANDYWINE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PEMBERTON
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08068-1307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-515-6125
Provider Business Practice Location Address Fax Number:
609-400-4888
Provider Enumeration Date:
03/24/2006

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: 208600000X , with the licence number:  25MA07284900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 44SL06624800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1000362700 . This is a "AMERICHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2720742 . This is a "AETNA USHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3319601 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: AMERIGROUP . This is a "60813" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1148032 . This is a "HORIZON NJ HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2009281000 . This is a "AMERIHEALTH/KEYSTONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2K3779 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2531958 . This is a "OXFORD HEALTHPLANS" identifier . This identifiers is of the category "OTHER".




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