Edgardo C Vallejo, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

25MA03310600 Issued in NJ

Practice address

240 Williamson St
Suite 502
Elizabeth, NJ 07202

Phone

(908) 352-1173

Fax

(908) 352-0665

NPI assigned

Oct 2, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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

Specialty

Internal Medicine

Education

Other, 1972

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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

• Edgardo C Vallejo Inc

  • Internal Medicine Physician
  • Elizabeth, NJ
  • NPI 1821302035
  NPD (past) Authorized official
• Trinitas Regional Medical Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Cranford, NJ
  • NPI 1518423698
  NPD (past)

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277683200000",
    "number": "1518050467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 WILLIAMSON ST",
            "address_2": "SUITE 502",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "07202",
            "telephone_number": "908-352-1173",
            "fax_number": "908-352-0665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 WILLIAMSON ST",
            "address_2": "SUITE 502",
            "city": "ELIZABETH",
            "state": "NJ",
            "postal_code": "07202",
            "telephone_number": "908-352-1173",
            "fax_number": "908-352-0665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALLEJO",
        "first_name": "EDGARDO",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2010-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NJ",
            "license": "25MA03310600",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1709801",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• United Medical Group 1 LLP
• Universal Care Group LLC
• University Medical Professionals LLC
• University Radiology at Trinitas, LLC
• Urban League of Union County, Inc.
• Raul Emilio Vasquez Duran, MD
• Teimouraz Vassilidze, M.D.
• Yeimi Vazquez, MS
• Jessica Velasquez-Julca
• Velixo DME

• Internal Medicine Physician in Elizabeth, NJ
• Providers in Elizabeth, NJ by specialty
• Internal Medicine Physician in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.