MEDICARE: DR. PRIYANK KHANDELWAL M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0129X	Vascular Surgery Physician	25MA10382600	NJ
2	2084N0400X	Neurology Physician	25MA10382600	NJ
3	2084V0102X	Vascular Neurology Physician	25MA10382600	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225347727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRIYANK KHANDELWAL M.D.

Provider Business Mailing Address
First Line	:	30 BERGEN ST RM 1205
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07107-3000
Country	:	US
Telephone Number	:	973-972-0037
Fax Number	:	973-972-0743

Provider Business Practice Location Address
First Line	:	90 BERGEN ST # 8100
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07103
Country	:	US
Telephone Number	:	973-972-2323
Fax Number	:	973-972-2333

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2010
Last Update Date	:	02/16/2026

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