Healthcare Provider Details

I. General information

NPI: 1215905070
Provider Name (Legal Business Name): PARVEEN UPPAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 HAZLET AVE STE# 3
HAZLET NJ
07730-1623
US

IV. Provider business mailing address

80 HAZLET AVE STE# 3
HAZLET NJ
07730-1623
US

V. Phone/Fax

Practice location:
  • Phone: 732-888-7901
  • Fax: 732-888-7905
Mailing address:
  • Phone: 732-888-7901
  • Fax: 732-888-7905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25MA06355400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: