Provider Demographics
NPI:1982689303
Name:LAKHANI, VIPUL K (MD)
Entity Type:Individual
Prefix:DR
First Name:VIPUL
Middle Name:K
Last Name:LAKHANI
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 1:4 AIR DANCER LN
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-1817
Mailing Address - Country:US
Mailing Address - Phone:732-244-4322
Mailing Address - Fax:732-244-4320
Practice Address - Street 1:413 LAKEHURST RD BLDG 1
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-7382
Practice Address - Country:US
Practice Address - Phone:732-244-4322
Practice Address - Fax:732-244-4320
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06737500207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
205532826OtherQUALCARE
1394163OtherAETNA
001752654OtherAPWU
NJ8037001Medicaid
205532826OtherCIGNA
205532826OtherUNITED HEALTHCARE
NJDF3909OtherRAILROAD MEDICARE
NJP2008161OtherOXFORD
NJ205532826OtherHORIZON BC BS
NJ027381Medicare PIN
NJDF3909OtherRAILROAD MEDICARE
NJ010737NAQMedicare PIN