MEDICARE: VIMLESH K ANISETTI 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	207L00000X	Anesthesiology Physician	25MA06351300	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902803455
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIMLESH K ANISETTI MD

Provider Business Mailing Address
First Line	:	655 SHREWSBURY AVE STE 308
Second Line	:
City	:	SHREWSBURY
State	:	NJ
Zip	:	07702-4151
Country	:	US
Telephone Number	:	848-379-2440
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 PLAZA DR STE 2-4
Second Line	:
City	:	TOMS RIVER
State	:	NJ
Zip	:	08757-3761
Country	:	US
Telephone Number	:	732-818-0059
Fax Number	:

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	07/28/2025

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