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Individual

DR. SURENDRA R. VASHI

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DMD

Contact information

Practice address
57 BROADWAY, NEWARK, NJ 07104-2503
(973) 481-3981
(973) 481-1082
Mailing address
57 BROADWAY, NEWARK, NJ 07104-2503
(973) 481-3981
(973) 481-1082

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DIO 17619
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1168217
HORIZON NJ HEALTH
NJ
01
17836
AMERIGROUP
NJ
01
300133795
TAX ID
NJ
01
336421
AMERICHOICE
NJ
05
4634501
NJ
Enumeration date
11/13/2006
Last updated
06/08/2012
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