Healthcare Provider Details

I. General information

NPI: 1396234969
Provider Name (Legal Business Name): KRISHAN CHIRIMUNJ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2018
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 KANE ST
WEST HARTFORD CT
06119-2110
US

IV. Provider business mailing address

61 BART PL
CLIFTON NJ
07013-1357
US

V. Phone/Fax

Practice location:
  • Phone: 860-523-3745
  • Fax:
Mailing address:
  • Phone: 201-960-5801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number69470
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD488181
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA11890400
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberC1-0027949
License Number StateDE
# 5
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberC1-0027949
License Number StateDE
# 6
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number25MA11890400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: