Healthcare Provider Details

I. General information

NPI: 1881662062
Provider Name (Legal Business Name): VIPIN GARG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 10/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 WILLIAMSON ST SUITE NUMBER 300
ELIZABETH NJ
07202-3674
US

IV. Provider business mailing address

240 WILLIAMSON ST SUITE NUMBER 300
ELIZABETH NJ
07202-3674
US

V. Phone/Fax

Practice location:
  • Phone: 908-994-8880
  • Fax: 908-360-0490
Mailing address:
  • Phone: 908-994-8880
  • Fax: 908-360-0490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMA70132
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMA70132
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07013200
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number220328
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberMA70132
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: