Provider Demographics
NPI:1427022607
Name:VANDENBURG, JAMES J III (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:J
Last Name:VANDENBURG
Suffix:III
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 1:1738 STATE ROUTE 31
Mailing Address - Street 2:SUITE 203
Mailing Address - City:CLINTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08809-2014
Mailing Address - Country:US
Mailing Address - Phone:908-735-4645
Mailing Address - Fax:
Practice Address - Street 1:1738 STATE ROUTE 31
Practice Address - Street 2:SUITE 203
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-2014
Practice Address - Country:US
Practice Address - Phone:908-735-4645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB06296000207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7348606Medicaid
NJ7348606Medicaid
NJ901326QDJMedicare PIN
NJG62486Medicare UPIN