Ketankumar Vaidya, LLC

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

MA74514 Issued in NJ

Legal business name

KETANKUMAR VAIDYA, LLC

Practice address

2149 Woodbridge Ave
Edison, NJ 08817-4474

Phone

(732) 985-2151

Fax

(732) 985-0650

NPI assigned

Feb 1, 2007

Last updated

Jun 11, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ketankumar N Vaidya, MDNPI 1487688586

Title

Owner

Phone

(732) 985-2151

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ketankumar N Vaidya, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Edison, NJ
  • NPI 1487688586
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339372800000",
    "number": "1417095845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 96",
            "city": "SEWAREN",
            "state": "NJ",
            "postal_code": "070770096",
            "telephone_number": "732-985-2151",
            "fax_number": "732-985-0650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2149 WOODBRIDGE AVE",
            "city": "EDISON",
            "state": "NJ",
            "postal_code": "088174474",
            "telephone_number": "732-985-2151",
            "fax_number": "732-985-0650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETANKUMAR VAIDYA, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-01",
        "last_updated": "2012-06-11",
        "status": "A",
        "authorized_official_last_name": "VAIDYA",
        "authorized_official_first_name": "KETANKUMAR",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-985-2151",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "NJ",
            "license": "MA74514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9002707",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Geriatric Medicine (Internal Medicine) Physician in Edison, NJ
• Providers in Edison, NJ by specialty
• Geriatric Medicine (Internal Medicine) Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.