Healthcare Provider Details

I. General information

NPI: 1295938496
Provider Name (Legal Business Name): SANJAY KUMAR M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 E CHESTNUT AVE
VINELAND NJ
08360-5002
US

IV. Provider business mailing address

2848 S DELSEA DR SUITE 4B
VINELAND NJ
08360-7042
US

V. Phone/Fax

Practice location:
  • Phone: 856-213-6375
  • Fax: 856-575-4986
Mailing address:
  • Phone: 856-205-7070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA08084100
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number25MA08084100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: