Healthcare Provider Details

I. General information

NPI: 1194785956
Provider Name (Legal Business Name): VIJAY R VASWANI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 BRANDYWINE RD
PEMBERTON NJ
08068-1307
US

IV. Provider business mailing address

30 BRANDYWINE RD
PEMBERTON NJ
08068-1307
US

V. Phone/Fax

Practice location:
  • Phone: 484-515-6125
  • Fax: 609-400-4888
Mailing address:
  • Phone: 484-515-6125
  • Fax: 609-400-4888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SL06624800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA07284900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: