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General NPI Number Information
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NPI Number | 1780792929
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Entity Type | Individual
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Provider Name | AJANTA SANJAY VINEKAR MD
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Gender | Female
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Dates
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Enumeration Date | 08/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1445 RTE 130 SOUTH
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City | NORTH BRUNSWICK
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State | NJ
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Zip | 08902
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Country | US
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Telephone | 732-940-9444
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Fax | 732-821-1449
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Provider Business Mailing Address
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Address Line | 11 BROOKSIDE CT
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City | CRANBURY
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State | NJ
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Zip | 08512
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Country | US
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Telephone | 609-731-7826
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Fax | 609-897-9189
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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 | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 25MA52053
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License Number State | NJ
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