Healthcare Provider Details

I. General information

NPI: 1588848212
Provider Name (Legal Business Name): CANDLEWOOD PEDIATRICS & ADOLESCENT MEDICINE,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CANDLEWOOD COMMONS
HOWELL NJ
07731-2170
US

IV. Provider business mailing address

PO BOX 577 300 CANDLEWOOD COMMONS
HOWELL NJ
07731-0577
US

V. Phone/Fax

Practice location:
  • Phone: 732-370-9600
  • Fax: 732-370-9656
Mailing address:
  • Phone: 732-370-9600
  • Fax: 732-370-9656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMA049581
License Number StateNJ

VIII. Authorized Official

Name: DR. SANGITA NAGPAL
Title or Position: DIRECTOR
Credential: M.D.
Phone: 732-370-9600