Healthcare Provider Details

I. General information

NPI: 1962692376
Provider Name (Legal Business Name): VASUDHA TULSYAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 LYONS AVE DEPARTMENT OF NEONATOLOGY
NEWARK NJ
07112-2027
US

IV. Provider business mailing address

1 BROOKFIELD DR
BASKING RIDGE NJ
07920-2602
US

V. Phone/Fax

Practice location:
  • Phone: 973-926-7203
  • Fax:
Mailing address:
  • Phone: 908-647-1718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number25MA07712400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: