Provider Demographics
NPI:1770516031
Name:SANKHLA, VIJAY R (MD)
Entity type:Individual
Prefix:
First Name:VIJAY
Middle Name:R
Last Name:SANKHLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 S BROADWAY
Mailing Address - Street 2:ATTN:INDIRA MARU - DOSHI SIAGNOSTIC IMAGING SERVICES
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-5027
Mailing Address - Country:US
Mailing Address - Phone:516-933-2800
Mailing Address - Fax:516-933-3122
Practice Address - Street 1:434 NEW JERSEY AVE
Practice Address - Street 2:
Practice Address - City:ABSECON
Practice Address - State:NJ
Practice Address - Zip Code:08201-2423
Practice Address - Country:US
Practice Address - Phone:609-383-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA045151002085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3830608Medicaid
NJ3830608Medicaid
NJE41450Medicare UPIN