Provider Demographics
NPI:1558312264
Name:SYSOUNTHONE, VILAYVANH (DPM)
Entity Type:Individual
Prefix:DR
First Name:VILAYVANH
Middle Name:
Last Name:SYSOUNTHONE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1259 US HIGHWAY 46
Mailing Address - Street 2:BUILDING 3
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-4913
Mailing Address - Country:US
Mailing Address - Phone:973-263-5500
Mailing Address - Fax:973-810-0943
Practice Address - Street 1:1259 US HIGHWAY 46
Practice Address - Street 2:BUILDING 3
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-4913
Practice Address - Country:US
Practice Address - Phone:973-263-5500
Practice Address - Fax:973-810-0943
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00286300213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery