Healthcare Provider Details

I. General information

NPI: 1942416763
Provider Name (Legal Business Name): KALA SHANKAR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 11/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 2ND ST
LAKEWOOD NJ
08701-3324
US

IV. Provider business mailing address

101 2ND ST
LAKEWOOD NJ
08701-3324
US

V. Phone/Fax

Practice location:
  • Phone: 732-363-6655
  • Fax: 732-363-6656
Mailing address:
  • Phone: 732-363-6655
  • Fax: 732-901-0277

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License NumberMA80380
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: