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General NPI Number Information
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NPI Number | 1053480475
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Entity Type | Individual
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Provider Name | VIKAS S. BAWA D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 09/04/2008
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Provider Practice Location Address
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Address Line | 1060 BROAD ST LOWER LEVEL MEDICAL OFFICE
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City | NEWARK
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State | NJ
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Zip | 07102-2397
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Country | US
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Telephone | 973-642-6500
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Fax | 973-741-2700
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Provider Business Mailing Address
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Address Line | 12 SHERWOOD LN
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City | COLUMBUS
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State | NJ
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Zip | 08022-2248
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Country | US
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Telephone | 973-906-3344
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 25MD00260200
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License Number State | NJ
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