Healthcare Provider Details

I. General information

NPI: 1356958839
Provider Name (Legal Business Name): KARAN KAMDAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 BERGEN AVE
JERSEY CITY NJ
07306
US

IV. Provider business mailing address

4 PERSIMMON CT
JERSEY CITY NJ
07305-4872
US

V. Phone/Fax

Practice location:
  • Phone: 201-371-3924
  • Fax:
Mailing address:
  • Phone: 951-227-1718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number40QA02255770
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: