Provider Demographics
NPI:1447232558
Name:MAHESHWARI, VIVEK (MD)
Entity Type:Individual
Prefix:
First Name:VIVEK
Middle Name:
Last Name:MAHESHWARI
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 1:101 OLD SHORT HILLS RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1000
Mailing Address - Country:US
Mailing Address - Phone:973-731-5005
Mailing Address - Fax:973-325-6230
Practice Address - Street 1:101 OLD SHORT HILLS RD
Practice Address - Street 2:SUITE 206
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1000
Practice Address - Country:US
Practice Address - Phone:973-731-5005
Practice Address - Fax:973-325-6230
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2011-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002247208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02605461Medicaid
105907PTFMedicare PIN
I22371Medicare UPIN