Individual
JAY ANDREW VIDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2125 RT 88 EAST, BRICK, NJ 08724-3152
(732) 892-4548
(732) 892-0961
Mailing address
27 S COOKS BRIDGE RD, JACKSON, NJ 08527-2524
(732) 942-4455
(732) 942-4459
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MB59096
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1212830001
MEDICARE NSC
NJ
05
—
7060602
—
NJ
Enumeration date
06/24/2005
Last updated
06/18/2018
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