MEDICARE: JAY ANDREW VIDA DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MB59096	NJ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1212830001	OTHER	NJ	MEDICARE NSC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831195601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY ANDREW VIDA DO

Provider Business Mailing Address
First Line	:	27 S COOKS BRIDGE RD
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-2524
Country	:	US
Telephone Number	:	732-942-4455
Fax Number	:	732-942-4459

Provider Business Practice Location Address
First Line	:	2125 RT 88 EAST
Second Line	:
City	:	BRICK
State	:	NJ
Zip	:	08724-3152
Country	:	US
Telephone Number	:	732-892-4548
Fax Number	:	732-892-0961

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	06/18/2018

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