Provider Demographics
NPI:1831122704
Name:BAHAL, VISHAL (DO, FASE, FACC, RPVI)
Entity Type:Individual
Prefix:DR
First Name:VISHAL
Middle Name:
Last Name:BAHAL
Suffix:
Gender:M
Credentials:DO, FASE, FACC, RPVI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 BURTON LN
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MULLICA HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08062-9422
Mailing Address - Country:US
Mailing Address - Phone:856-241-3838
Mailing Address - Fax:856-241-3849
Practice Address - Street 1:4 BURTON LN
Practice Address - Street 2:SUITE 100
Practice Address - City:MULLICA HILL
Practice Address - State:NJ
Practice Address - Zip Code:08062-9422
Practice Address - Country:US
Practice Address - Phone:856-241-3838
Practice Address - Fax:856-241-3849
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008639L207RC0000X
NJ25MB06965800207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0021458Medicaid
NJH07350Medicare UPIN
NJ0021458Medicaid