Healthcare Provider Details

I. General information

NPI: 1255891131
Provider Name (Legal Business Name): KRUPA GANDHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 MILLBURN AVE STE 106
MILLBURN NJ
07041-1933
US

IV. Provider business mailing address

90 MILLBURN AVE STE 106
MILLBURN NJ
07041-1933
US

V. Phone/Fax

Practice location:
  • Phone: 973-309-6192
  • Fax: 973-440-3696
Mailing address:
  • Phone: 973-309-6192
  • Fax: 973-440-3696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA11754900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: