Healthcare Provider Details

I. General information

NPI: 1225560063
Provider Name (Legal Business Name): KAPIL WATTAMWAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 GRAND ST
JERSEY CITY NJ
07302-4321
US

IV. Provider business mailing address

355 GRAND ST
JERSEY CITY NJ
07302-4321
US

V. Phone/Fax

Practice location:
  • Phone: 201-915-2000
  • Fax:
Mailing address:
  • Phone: 201-915-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number323663
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number25MA13222100
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number323663
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number25MA13222100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: