Healthcare Provider Details

I. General information

NPI: 1093275729
Provider Name (Legal Business Name): KAILASH KAPADIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 MILLBURN AVE
MILLBURN NJ
07041-1825
US

IV. Provider business mailing address

171 MILLBURN AVE
MILLBURN NJ
07041-1825
US

V. Phone/Fax

Practice location:
  • Phone: 732-945-6555
  • Fax:
Mailing address:
  • Phone: 732-945-6555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License Number25MA12285800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: