Provider Demographics
NPI:1326236308
Name:VIJAY-SHARMA, MAYURI (MD)
Entity Type:Individual
Prefix:
First Name:MAYURI
Middle Name:
Last Name:VIJAY-SHARMA
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 1:111 NORTHFIELD AVE
Mailing Address - Street 2:SUITE 311
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-4795
Mailing Address - Country:US
Mailing Address - Phone:973-325-2103
Mailing Address - Fax:
Practice Address - Street 1:111 NORTHFIELD AVE
Practice Address - Street 2:SUITE 311
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-4795
Practice Address - Country:US
Practice Address - Phone:973-325-2103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08277600207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine