Healthcare Provider Details

I. General information

NPI: 1124183017
Provider Name (Legal Business Name): MINAL VAZIRANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 11/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S ORANGE AVE SUITE 116
LIVINGSTON NJ
07039-5817
US

IV. Provider business mailing address

200 S ORANGE AVE SUITE 116
LIVINGSTON NJ
07039-5817
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-7007
  • Fax: 973-322-7436
Mailing address:
  • Phone: 973-322-7007
  • Fax: 973-322-7436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number247683
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number247683
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA08107300
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08107300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: