Healthcare Provider Details

I. General information

NPI: 1073701819
Provider Name (Legal Business Name): PARUL M KADAKIA PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 09/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 CORLIES AVE STE 12
NEPTUNE NJ
07753-6116
US

IV. Provider business mailing address

2100 CORLIES AVE STE 12
NEPTUNE NJ
07753-6116
US

V. Phone/Fax

Practice location:
  • Phone: 732-263-7960
  • Fax:
Mailing address:
  • Phone: 732-263-7960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number012282
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberP61126
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number25MP00263500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: