| Ketankumar Vaidya, Llc | |
|
2149 Woodbridge Ave Edison NJ 08817-4474 | |
| (732) 985-2151 | |
| (732) 985-0650 |
| Full Name | Ketankumar Vaidya, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2149 Woodbridge Ave, Edison, New Jersey |
| Authorized Official Name and Position | Ketankumar N Vaidya (OWNER) |
| Authorized Official Contact | 7329852151 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ketankumar Vaidya, Llc Po Box 96 Sewaren NJ 07077-0096 Ph: (732) 985-2151 | Ketankumar Vaidya, Llc 2149 Woodbridge Ave Edison NJ 08817-4474 Ph: (732) 985-2151 |
| NPI Number | 1417095845 |
|---|---|
| Provider Enumeration Date | 02/01/2007 |
| Last Update Date | 06/11/2012 |
| Medicare PECOS PAC ID | 0244297109 |
|---|---|
| Medicare Enrollment ID | O20041213000881 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417095845 | NPI | - | NPPES |
| 9002707 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | MA74514 (New Jersey) | Primary |
| Provider Name | Ketankumar N Vaidya |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1487688586 PECOS PAC ID: 1850379280 Enrollment ID: I20040712000554 |
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