Active NPI
Surendra R. Vashi, DMD
- General Practice Dentistry
- Newark, NJ
National Provider Identifier
1629140157
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DIO 17619
- Practice address
- 57 Broadway
Newark, NJ 07104-2503 - Phone
- (973) 481-3981
- Fax
- (973) 481-1082
- NPI assigned
- Nov 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DIO 17619 | NJ | Primary |
Addresses
Primary practice location
57 Broadway
Newark, NJ 07104-2503
Mailing address
57 Broadway
Newark, NJ 07104-2503
Phone (973) 481-3981
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1168217 | Other | NJ | HORIZON NJ HEALTH |
| 17836 | Other | NJ | AMERIGROUP |
| 336421 | Other | NJ | AMERICHOICE |
| 300133795 | Other | NJ | TAX ID |
| 4634501 | Medicaid | NJ |
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: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160421000412 | NJ | Order and Referring Only - Dentist | 0648578898 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DIO 17619 | NJ | MD | General Practice Dentistry |
Interoperability endpoints
- surendra.vashi@nchc.eclinicaldirectplus.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339113600000",
"number": "1629140157",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "57 BROADWAY",
"city": "NEWARK",
"state": "NJ",
"postal_code": "071042503",
"telephone_number": "973-481-3981",
"fax_number": "973-481-1082"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "57 BROADWAY",
"city": "NEWARK",
"state": "NJ",
"postal_code": "071042503",
"telephone_number": "973-481-3981",
"fax_number": "973-481-1082"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VASHI",
"first_name": "SURENDRA",
"middle_name": "R.",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-13",
"last_updated": "2012-06-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NJ",
"license": "DIO 17619",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HORIZON NJ HEALTH",
"identifier": "1168217",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP",
"identifier": "17836",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERICHOICE",
"identifier": "336421",
"state": "NJ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "300133795",
"state": "NJ"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4634501",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Newark, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2012; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.