Healthcare Provider Details

I. General information

NPI: 1497708358
Provider Name (Legal Business Name): PUNAM KASHYAP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE
HACKENSACK NJ
07601-1914
US

IV. Provider business mailing address

385 GLENWOOD RD
RIDGEWOOD NJ
07450-1229
US

V. Phone/Fax

Practice location:
  • Phone: 201-996-5204
  • Fax: 201-489-1892
Mailing address:
  • Phone: 201-996-5204
  • Fax: 201-489-1892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number042401
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: