Healthcare Provider Details

I. General information

NPI: 1730448655
Provider Name (Legal Business Name): KAILASH C DHUPAR PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2012
Last Update Date: 05/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 WALNUT ST W
MAHWAH NJ
07430-3128
US

IV. Provider business mailing address

6 WALNUT ST W
MAHWAH NJ
07430-3128
US

V. Phone/Fax

Practice location:
  • Phone: 201-485-8304
  • Fax:
Mailing address:
  • Phone: 201-485-8304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number038088
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: