Healthcare Provider Details

I. General information

NPI: 1962796664
Provider Name (Legal Business Name): VEDER & VEDER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2011
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1676 N OLDEN AVE
EWING NJ
08638-3209
US

IV. Provider business mailing address

PO BOX 302
MANALAPAN NJ
07726-0302
US

V. Phone/Fax

Practice location:
  • Phone: 609-434-0041
  • Fax: 732-831-6171
Mailing address:
  • Phone: 646-522-3664
  • Fax: 732-831-6171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA08792700
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number25MA08792700
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number25MA08792700
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25MA08899900
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number25MA08899900
License Number StateNJ
# 6
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number25MA08792700
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number25MA08792700
License Number StateNJ
# 8
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number25MA08899900
License Number StateNJ

VIII. Authorized Official

Name: ALEXANDER VEDER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 646-522-3664