Healthcare Provider Details

I. General information

NPI: 1205387065
Provider Name (Legal Business Name): NISHA VIJAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 05/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 J ARI DRIVE
SOMERSET NJ
08873
US

IV. Provider business mailing address

5 J ARI DRIVE
SOMERSET NJ
08873
US

V. Phone/Fax

Practice location:
  • Phone: 732-422-1044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number26NJ00723700
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number707472
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: