Provider Demographics
NPI:1508172727
Name:VIGILANT ANESTHESIA
Entity Type:Organization
Organization Name:VIGILANT ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JON-PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:DADAIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-204-2645
Mailing Address - Street 1:434 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:WALLINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07057-1830
Mailing Address - Country:US
Mailing Address - Phone:973-365-5844
Mailing Address - Fax:973-365-5811
Practice Address - Street 1:434 MAIN AVE
Practice Address - Street 2:
Practice Address - City:WALLINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07057-1830
Practice Address - Country:US
Practice Address - Phone:973-365-5844
Practice Address - Fax:973-365-5811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08092000207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty