=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962702118
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | VIJU VIJAYSADAN MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2010
-----------------------------------------------------
Last Update Date | 10/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 225 ROUTE 10 E
-----------------------------------------------------
City | SUCCASUNNA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07876-1300
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-584-5584
-----------------------------------------------------
Fax | 973-251-9031
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 63 BEAVERBROOK RD STE 101
-----------------------------------------------------
City | LINCOLN PARK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07035-1440
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 973-584-9984
-----------------------------------------------------
Fax | 845-544-1716
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL BILLING ADMINISTRATOR
-----------------------------------------------------
Name | MS. DEBRA ANN SCIALPI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-584-9984
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 25MA08006300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 313M00000X
-----------------------------------------------------
Taxonomy Name | Nursing Facility/Intermediate Care Facility
-----------------------------------------------------
License Number | 25MA08006300
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------