Healthcare Provider Details

I. General information

NPI: 1053302976
Provider Name (Legal Business Name): TUSHARKUMAR N MISTRY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 COUNTY ROAD 520 STE A
ENGLISHTOWN NJ
07726-8478
US

IV. Provider business mailing address

8 COUNTY ROAD 520 STE A
ENGLISHTOWN NJ
07726-8478
US

V. Phone/Fax

Practice location:
  • Phone: 732-679-4200
  • Fax: 732-851-4532
Mailing address:
  • Phone: 732-679-4200
  • Fax: 732-851-4532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25MA07930800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA07930800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: