Provider Demographics
NPI:1255385233
Name:OBUZ, VEDAT (MD)
Entity type:Individual
Prefix:DR
First Name:VEDAT
Middle Name:
Last Name:OBUZ
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 1:292 MELROSE AVE
Mailing Address - Street 2:
Mailing Address - City:MERION STATION
Mailing Address - State:PA
Mailing Address - Zip Code:19066-1716
Mailing Address - Country:US
Mailing Address - Phone:609-937-2297
Mailing Address - Fax:610-819-0222
Practice Address - Street 1:515 S BROAD ST
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08611-1819
Practice Address - Country:US
Practice Address - Phone:609-392-6950
Practice Address - Fax:609-392-6739
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA63577207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7700903Medicaid
NJG63798Medicare UPIN
NJ064874Medicare ID - Type Unspecified