Healthcare Provider Details

I. General information

NPI: 1932299922
Provider Name (Legal Business Name): KALYANI DESHPANDE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4326 ROUTE 1 NORTH
MONMOUTH JUNCTION NJ
08852
US

IV. Provider business mailing address

671 HOES LN
PISCATAWAY NJ
08854-5627
US

V. Phone/Fax

Practice location:
  • Phone: 800-969-5300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA07315100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: