Provider Demographics
NPI:1114033495
Name:BAXI, VIBHAKAR KANTILAL (MD)
Entity Type:Individual
Prefix:
First Name:VIBHAKAR
Middle Name:KANTILAL
Last Name:BAXI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:220 HAMBURG TPK
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470
Mailing Address - Country:US
Mailing Address - Phone:973-595-0032
Mailing Address - Fax:973-389-9976
Practice Address - Street 1:220 HAMBURG TPK
Practice Address - Street 2:SUITE 2
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470
Practice Address - Country:US
Practice Address - Phone:973-595-0032
Practice Address - Fax:973-389-9976
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA40736208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
A98169Medicare UPIN
NJ446944Medicare ID - Type Unspecified