Provider Demographics
NPI:1659322204
Name:VAIDYA, PRANAYCHANDRA J (MD, FACC)
Entity Type:Individual
Prefix:
First Name:PRANAYCHANDRA
Middle Name:J
Last Name:VAIDYA
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:PRANAY
Other - Middle Name:J
Other - Last Name:VAIDYA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD, FACC
Mailing Address - Street 1:211 ESSEX ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-3231
Mailing Address - Country:US
Mailing Address - Phone:201-343-2050
Mailing Address - Fax:201-343-4512
Practice Address - Street 1:211 ESSEX ST
Practice Address - Street 2:SUITE 306
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-3231
Practice Address - Country:US
Practice Address - Phone:201-343-2050
Practice Address - Fax:201-343-4512
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03112600207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ460709BU4Medicare ID - Type Unspecified
NJD07163Medicare UPIN