Healthcare Provider Details

I. General information

NPI: 1962269415
Provider Name (Legal Business Name): VISHAL RAMA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2035 LINCOLN HWY
EDISON NJ
08817-3351
US

IV. Provider business mailing address

2035 LINCOLN HWY
EDISON NJ
08817-3351
US

V. Phone/Fax

Practice location:
  • Phone: 732-800-9000
  • Fax:
Mailing address:
  • Phone: 732-800-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00849600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: