Individual provider Active NPI

Victoria Eligulashvili, MD

  • Emergency Medicine Physician
  • Vineland, NJ
National Provider Identifier
1427219310
Registry record updated Jun 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
23MA08396700 Issued in NJ
Practice address
1505 W Sherman Ave
Vineland, NJ 08360-6912
Phone
(856) 641-8000
NPI assigned
Jun 23, 2008
Last updated
Jun 23, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 23MA08396700 NJ Primary

Addresses

Primary practice location

1505 W Sherman Ave
Vineland, NJ 08360-6912

Mailing address

307 S Evergreen Ave
Woodbury, NJ 08096-2739
Phone (856) 686-4317

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081001000649 NJ Practitioner - Emergency Medicine 4183792344 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Jersey Hyperbaric Medicine LLCGroup PAC ID 9436427499, 28 clinicians

Practice addresses (Care Compare)

501 Front St
Elmer, NJ 08318-2101
Phone (856) 363-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
23MA08396700NJMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Jersey Health System Emergency Physician Services P a Emergency Medicine CurrentSince Jul 1, 2008 Accepting new patients
South Jersey Hyperbaric Medicine LLC CurrentSince Aug 13, 2020 Accepting new patients

Locations

333 Irving Ave
Bridgeton, NJ 08302
Phone (856) 575-4500

1505 W Sherman Ave
Vineland, NJ 08360
Phone (856) 451-6600

307 S Evergreen Ave
Woodbury, NJ 08096
Phone (856) 686-4300

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1214179200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214179200000",
    "number": "1427219310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 S EVERGREEN AVE",
            "city": "WOODBURY",
            "state": "NJ",
            "postal_code": "080962739",
            "telephone_number": "856-686-4317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1505 W SHERMAN AVE",
            "city": "VINELAND",
            "state": "NJ",
            "postal_code": "083606912",
            "telephone_number": "856-641-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELIGULASHVILI",
        "first_name": "VICTORIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-23",
        "last_updated": "2008-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NJ",
            "license": "23MA08396700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vineland, NJ

Sources for this page

Verify at the official NPI Registry.