Provider Demographics
NPI:1194785956
Name:VASWANI, VIJAY R (MD)
Entity type:Individual
Prefix:
First Name:VIJAY
Middle Name:R
Last Name:VASWANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 BRANDYWINE RD
Mailing Address - Street 2:
Mailing Address - City:PEMBERTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08068-1307
Mailing Address - Country:US
Mailing Address - Phone:484-515-6125
Mailing Address - Fax:609-400-4888
Practice Address - Street 1:30 BRANDYWINE RD
Practice Address - Street 2:
Practice Address - City:PEMBERTON
Practice Address - State:NJ
Practice Address - Zip Code:08068-1307
Practice Address - Country:US
Practice Address - Phone:484-515-6125
Practice Address - Fax:609-400-4888
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07284900208600000X
NJ44SL066248001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1000362700OtherAMERICHOICE
2720742OtherAETNA USHC
NJ3319601Medicaid
AMERIGROUPOther60813
1148032OtherHORIZON NJ HEALTH
2009281000OtherAMERIHEALTH/KEYSTONE
2K3779OtherHEALTHNET
P2531958OtherOXFORD HEALTHPLANS
1148032OtherHORIZON NJ HEALTH
NJ050171Medicare PIN