Healthcare Provider Details

I. General information

NPI: 1962702118
Provider Name (Legal Business Name): VIJU VIJAYSADAN MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 ROUTE 10 E
SUCCASUNNA NJ
07876-1300
US

IV. Provider business mailing address

63 BEAVERBROOK RD STE 101
LINCOLN PARK NJ
07035-1440
US

V. Phone/Fax

Practice location:
  • Phone: 973-584-5584
  • Fax: 973-251-9031
Mailing address:
  • Phone: 973-584-9984
  • Fax: 845-544-1716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number25MA08006300
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number25MA08006300
License Number StateNJ

VIII. Authorized Official

Name: MS. DEBRA ANN SCIALPI
Title or Position: MEDICAL BILLING ADMINISTRATOR
Credential:
Phone: 973-584-9984