Healthcare Provider Details

I. General information

NPI: 1508190786
Provider Name (Legal Business Name): ESAD VUCIC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2009
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

741 BROADWAY
NEWARK NJ
07104-4309
US

IV. Provider business mailing address

455 CHASE PKWY
WATERBURY CT
06708-3352
US

V. Phone/Fax

Practice location:
  • Phone: 201-675-1900
  • Fax: 973-676-1396
Mailing address:
  • Phone: 203-573-1435
  • Fax: 203-753-1096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number052214
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA10601800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number052214
License Number StateCT
# 4
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number25MA10601800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: