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Organization

KETANKUMAR VAIDYA, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KETANKUMAR N VAIDYA MD (OWNER)
(732) 985-2151
Entity
Organization

Contact information

Practice address
2149 WOODBRIDGE AVE, EDISON, NJ 08817-4474
(732) 985-2151
(732) 985-0650
Mailing address
PO BOX 96, SEWAREN, NJ 07077-0096
(732) 985-2151
(732) 985-0650

Taxonomy

Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
MA74514
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
9002707
NJ
Enumeration date
02/01/2007
Last updated
06/11/2012
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