Provider Demographics
NPI:1669573648
Name:NIMMA, VIJAYA (MD)
Entity type:Individual
Prefix:
First Name:VIJAYA
Middle Name:
Last Name:NIMMA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 OAK TREE AVE STE A
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-5127
Mailing Address - Country:US
Mailing Address - Phone:732-902-6395
Mailing Address - Fax:
Practice Address - Street 1:6 NICHOLAS CT
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-2244
Practice Address - Country:US
Practice Address - Phone:732-902-6395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07473400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0003603Medicaid
NJH88249Medicare UPIN