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General NPI Number Information
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NPI Number | 1912176793
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Entity Type | Organization
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Legal Business Name | SURENDRA R VASHI, D. MD.,P.A.
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Dates
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Enumeration Date | 02/26/2008
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Last Update Date | 02/26/2008
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Provider Practice Location Address
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Address Line | 57 BROADWAY
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City | NEWARK
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State | NJ
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Zip | 07104-2503
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Country | US
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Telephone | 973-481-3981
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Fax | 973-481-1082
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Provider Business Mailing Address
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Address Line | 57 BROADWAY
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City | NEWARK
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State | NJ
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Zip | 07104-2503
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Country | US
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Telephone | 973-481-3981
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Fax | 973-481-1082
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ROSIO M PALACIOS
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Credential |
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Telephone | 973-481-3981
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 17619
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License Number State | NJ
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