Healthcare Provider Details

I. General information

NPI: 1023750601
Provider Name (Legal Business Name): BANSARI VYAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

94 OLD SHORT HILLS RD
LIVINGSTON NJ
07039-5672
US

IV. Provider business mailing address

3 MADISON CT
MONTVILLE NJ
07045
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-5000
  • Fax:
Mailing address:
  • Phone: 973-747-7795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA12716800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: