MEDICARE: DR. VANDAN DIPAK UPADHYAYA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0011X	Interventional Cardiology Physician	25MA11137500	NJ

General Provider Information

NPI Number	:	1790279396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VANDAN DIPAK UPADHYAYA MD

Provider Business Mailing Address
First Line	:	1945 STATE ROUTE 33
Second Line	:
City	:	NEPTUNE
State	:	NJ
Zip	:	07753-4859
Country	:	US
Telephone Number	:	732-776-4483
Fax Number	:	732-776-4798

Provider Business Practice Location Address
First Line	:	39 BRENTWOOD RD STE 101
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8031
Country	:	US
Telephone Number	:	631-591-7400
Fax Number	:	631-591-7401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2018
Last Update Date	:	04/06/2026

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