Healthcare Provider Details

I. General information

NPI: 1386819589
Provider Name (Legal Business Name): VIVEK V SAILAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 02/14/2024
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 HURFFVILLE CROSSKEYS RD STE 101
SEWELL NJ
08080-4011
US

IV. Provider business mailing address

120 WHITE HORSE PIKE STE 112
HADDON HEIGHTS NJ
08035-1994
US

V. Phone/Fax

Practice location:
  • Phone: 856-582-2000
  • Fax: 856-582-2061
Mailing address:
  • Phone: 856-547-0539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD425179
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA08398800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: