Healthcare Provider Details

I. General information

NPI: 1790678753
Provider Name (Legal Business Name): MIND AND BODY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 SAINT MORITZ LN
CHERRY HILL NJ
08003-5122
US

IV. Provider business mailing address

28 SAINT MORITZ LN
CHERRY HILL NJ
08003-5122
US

V. Phone/Fax

Practice location:
  • Phone: 732-659-1051
  • Fax:
Mailing address:
  • Phone: 732-659-1051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KARUNA S PODDAR
Title or Position: OWNER
Credential: MD
Phone: 732-659-1051