Provider Demographics
NPI:1376757435
Name:VYAS, RAJIV KRISHNAKANT (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJIV
Middle Name:KRISHNAKANT
Last Name:VYAS
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 1:15 SOMERTON SQ
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-3366
Mailing Address - Country:US
Mailing Address - Phone:609-953-7882
Mailing Address - Fax:
Practice Address - Street 1:215 S BURLINGTON RD
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-3479
Practice Address - Country:US
Practice Address - Phone:856-459-7224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA071822002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry