Healthcare Provider Details

I. General information

NPI: 1427094226
Provider Name (Legal Business Name): MELVIN P. VIGMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 MAPLE ST SUITE 104
SUMMIT NJ
07901-2571
US

IV. Provider business mailing address

47 MAPLE ST STE 104
SUMMIT NJ
07901-2571
US

V. Phone/Fax

Practice location:
  • Phone: 908-277-2722
  • Fax: 908-273-5970
Mailing address:
  • Phone: 908-277-2722
  • Fax: 908-273-5970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMA24751
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: