Provider Demographics
NPI:1881616084
Name:VIRADIA, JAYANT (MD)
Entity type:Individual
Prefix:
First Name:JAYANT
Middle Name:
Last Name:VIRADIA
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:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-0297
Mailing Address - Country:US
Mailing Address - Phone:732-899-0868
Mailing Address - Fax:732-899-5167
Practice Address - Street 1:360 HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5823
Practice Address - Country:US
Practice Address - Phone:732-942-9835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05033200207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5218403Medicaid
NJ715644Medicare ID - Type Unspecified
NJ5218403Medicaid