Provider Demographics
NPI:1114924487
Name:VASISHT, BHUPESH (MD)
Entity Type:Individual
Prefix:
First Name:BHUPESH
Middle Name:
Last Name:VASISHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1307 WHITE HORSE RD
Mailing Address - Street 2:SUITE E501
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-2176
Mailing Address - Country:US
Mailing Address - Phone:856-784-2639
Mailing Address - Fax:856-784-2659
Practice Address - Street 1:1307 WHITE HORSE RD
Practice Address - Street 2:SUITE E501
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-2176
Practice Address - Country:US
Practice Address - Phone:856-784-2639
Practice Address - Fax:856-784-2659
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA71305208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ093419UHHMedicare PIN