Provider Demographics
NPI:1114375631
Name:PUROHIT, VAISHALI A (MD)
Entity Type:Individual
Prefix:
First Name:VAISHALI
Middle Name:A
Last Name:PUROHIT
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 1:200 SCHULZ DR STE 2
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-6745
Mailing Address - Country:US
Mailing Address - Phone:732-426-3420
Mailing Address - Fax:732-747-2606
Practice Address - Street 1:257 LAFAYETTE AVE STE 200
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-4837
Practice Address - Country:US
Practice Address - Phone:732-741-0970
Practice Address - Fax:732-747-2606
Is Sole Proprietor?:No
Enumeration Date:2016-05-25
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD465038208600000X
NJ25MA12046500208600000X
NY327174208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
15684917OtherCAQH