Provider Demographics
NPI:1538110754
Name:VIJAYSADAN, VIJU (MD)
Entity Type:Individual
Prefix:DR
First Name:VIJU
Middle Name:
Last Name:VIJAYSADAN
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 1:170 KINNELON RD
Mailing Address - Street 2:SUITE 28
Mailing Address - City:KINNELON
Mailing Address - State:NJ
Mailing Address - Zip Code:07405-2347
Mailing Address - Country:US
Mailing Address - Phone:973-838-7650
Mailing Address - Fax:973-838-1775
Practice Address - Street 1:170 KINNELON RD
Practice Address - Street 2:SUITE 28
Practice Address - City:KINNELON
Practice Address - State:NJ
Practice Address - Zip Code:07405-2347
Practice Address - Country:US
Practice Address - Phone:973-838-7650
Practice Address - Fax:973-838-1775
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08006300207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ183311WH9Medicare PIN