Provider Demographics
NPI:1487684858
Name:DAS, VIVEK T (MD)
Entity Type:Individual
Prefix:DR
First Name:VIVEK
Middle Name:T
Last Name:DAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:726 ROUTE 202 S. SUITE 320-332
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807
Mailing Address - Country:US
Mailing Address - Phone:908-904-1900
Mailing Address - Fax:908-904-1908
Practice Address - Street 1:501 OMNI DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4528
Practice Address - Country:US
Practice Address - Phone:908-904-1900
Practice Address - Fax:908-904-1908
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05994100208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6497608Medicaid
NJ095458Medicare PIN
NJG04491Medicare UPIN