Provider Demographics
NPI:1568410249
Name:GHETIYA, VINODRAI VIRJI (MD)
Entity Type:Individual
Prefix:
First Name:VINODRAI
Middle Name:VIRJI
Last Name:GHETIYA
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 1:1749 HOOPER AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-8130
Mailing Address - Country:US
Mailing Address - Phone:732-864-7030
Mailing Address - Fax:732-864-7032
Practice Address - Street 1:1749 HOOPER AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-8130
Practice Address - Country:US
Practice Address - Phone:732-864-7030
Practice Address - Fax:732-864-7032
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06495500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG61545Medicare UPIN