Healthcare Provider Details

I. General information

NPI: 1124249081
Provider Name (Legal Business Name): LAKSHMI KESARWALA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3084 STATE ROUTE 27 SUITE 6
KENDALL PARK NJ
08824-1657
US

IV. Provider business mailing address

3084 STATE ROUTE 27 SUITE 6
KENDALL PARK NJ
08824-1657
US

V. Phone/Fax

Practice location:
  • Phone: 732-821-0595
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA03461700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: