Provider Demographics
NPI:1780792929
Name:VINEKAR, AJANTA SANJAY (MD)
Entity type:Individual
Prefix:MRS
First Name:AJANTA
Middle Name:SANJAY
Last Name:VINEKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AJANTA
Other - Middle Name:SKARAD
Other - Last Name:TAGGARSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 BROOKSIDE CT
Mailing Address - Street 2:
Mailing Address - City:CRANBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08512
Mailing Address - Country:US
Mailing Address - Phone:609-731-7826
Mailing Address - Fax:609-897-9189
Practice Address - Street 1:1445 RTE 130 SOUTH
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902
Practice Address - Country:US
Practice Address - Phone:732-940-9444
Practice Address - Fax:732-821-1449
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA520532084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3673707Medicaid
E53501Medicare UPIN
NJ567751Medicare ID - Type Unspecified