NPIMap

Organization Active NPI

Edgardo C Vallejo Inc

Doing business as Edgardo Vallejo MD

  • Internal Medicine Physician
  • Elizabeth, NJ
National Provider Identifier
1821302035
Registry record updated Jul 29, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
25MA03310600 Issued in NJ
Legal business name
EDGARDO C VALLEJO INC
Doing business as
Edgardo Vallejo MD
Practice address
240 Williamson St
Suite 502
Elizabeth, NJ 07202-3674
Phone
(908) 352-1173
Fax
(908) 352-0665
NPI assigned
Jul 29, 2010
Last updated
Jul 29, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 29, 2010

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

Authorized official

Name
Dr. Edgardo C Vallejo, M.D.NPI 1518050467
Title
President
Phone
(908) 352-1173

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 25MA03310600 NJ Primary

Addresses

Primary practice location

240 Williamson St
Suite 502
Elizabeth, NJ 07202-3674

Mailing address

240 Williamson St
Suite 502
Elizabeth, NJ 07202-3674
Phone (908) 352-1173

Other identifiers 1

IdentifierTypeStateIssuer
1709801MedicaidNJ

Other names 1

  • Edgardo Vallejo MD Doing business as

National Provider Directory

National Provider Directory

Locations

240 Williamson St
Ste 502
Elizabeth, NJ 07202
Phone (908) 352-1173

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1280361600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280361600000",
    "number": "1821302035",
    "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": "072023674",
            "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": "072023674",
            "telephone_number": "908-352-1173",
            "fax_number": "908-352-0665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGARDO C VALLEJO INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-07-29",
        "last_updated": "2010-07-29",
        "status": "A",
        "authorized_official_last_name": "VALLEJO",
        "authorized_official_first_name": "EDGARDO",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "908-352-1173",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "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": [
        {
            "organization_name": "Edgardo Vallejo MD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elizabeth, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.