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General NPI Number Information
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NPI Number | 1508172727
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Entity Type | Organization
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Legal Business Name | VIGILANT ANESTHESIA
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Dates
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Enumeration Date | 08/25/2010
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Last Update Date | 08/25/2010
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Provider Practice Location Address
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Address Line | 434 MAIN AVE
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City | WALLINGTON
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State | NJ
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Zip | 07057-1830
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Country | US
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Telephone | 973-365-5844
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Fax | 973-365-5811
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Provider Business Mailing Address
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Address Line | 434 MAIN AVE
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City | WALLINGTON
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State | NJ
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Zip | 07057-1830
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Country | US
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Telephone | 973-365-5844
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Fax | 973-365-5811
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Authorized Official
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Title or Position | CHAIRMAN
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Name | DR. JON-PAUL DADAIAN
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Credential | M.D.
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Telephone | 973-204-2645
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 25MA08092000
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License Number State | NJ
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