Provider Demographics
NPI:1710925078
Name:VARDY, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:VARDY
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 1:7 PARK ST
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-2217
Mailing Address - Country:US
Mailing Address - Phone:646-345-5249
Mailing Address - Fax:
Practice Address - Street 1:350 ENGLE ST
Practice Address - Street 2:SUITE 5 W MED SUITE
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-1808
Practice Address - Country:US
Practice Address - Phone:201-894-3690
Practice Address - Fax:201-894-5264
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07428500207VG0400X
NY192807-1207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7390335OtherAETNA NJ
NJ2K9049OtherHEALTHNET
NJ1773062OtherUHC,HMOPOS,PPO,EPO,INDEMN
NJP2718729OtherOXF, LIBERTY,FREEDOM,MEDI
NJ1061711OtherAETNA HMO
NJ71622618OtherHORIZON HEALTHCARE OF NJ
NJ0567268OtherCIGNA
NJP2718729OtherOXF, LIBERTY,FREEDOM,MEDI
NJ2K9049OtherHEALTHNET