Provider Demographics
NPI:1043389083
Name:VIJAYAKUMAR, ASHA M (MD)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:M
Last Name:VIJAYAKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 AVENUE I
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831
Mailing Address - Country:US
Mailing Address - Phone:908-477-7011
Mailing Address - Fax:888-808-8229
Practice Address - Street 1:152 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:CLARK
Practice Address - State:NJ
Practice Address - Zip Code:07066-1115
Practice Address - Country:US
Practice Address - Phone:732-382-9700
Practice Address - Fax:732-382-9707
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2015-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07882600207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0121924Medicaid
NJ097045N4XMedicare PIN