Basic Information
Provider Information
NPI: 1598965071
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VAZIRANI
FirstName: TINA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 475 COUNTY ROAD 520
Address2: SUITE 201
City: MARLBORO
State: NJ
PostalCode: 077461059
CountryCode: US
TelephoneNumber: 7323702220
FaxNumber: 7325487408
Practice Location
Address1: 475 COUNTY ROAD 520
Address2: SUITE 201
City: MARLBORO
State: NJ
PostalCode: 077461059
CountryCode: US
TelephoneNumber: 7323702220
FaxNumber: 7325487408
Other Information
ProviderEnumerationDate: 07/23/2007
LastUpdateDate: 07/31/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RG0100X25MA09344000NJY Allopathic & Osteopathic PhysiciansInternal MedicineGastroenterology

No ID Information.


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