=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609000199
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DARSHAN C VAIDYA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2009
-----------------------------------------------------
Last Update Date | 06/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5 CENTRE DR SUITE 1A
-----------------------------------------------------
City | MONROE TOWNSHIP
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08831-1864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-655-4544
-----------------------------------------------------
Fax | 609-655-2390
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5 CENTRE DR SUITE 1A
-----------------------------------------------------
City | MONROE TOWNSHIP
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08831-1864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-655-4544
-----------------------------------------------------
Fax | 609-655-2390
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 25MA09072300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------