Healthcare Provider Details

I. General information

NPI: 1992507131
Provider Name (Legal Business Name): VIJAY SOMESH RAO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2025
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 CLARKSVILLE RD STE 7
PRINCETON JUNCTION NJ
08550-5375
US

IV. Provider business mailing address

4300 SPRUCE ST APT A302
PHILADELPHIA PA
19104-4700
US

V. Phone/Fax

Practice location:
  • Phone: 609-269-5705
  • Fax:
Mailing address:
  • Phone: 609-571-6682
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI03127000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: