Healthcare Provider Details

I. General information

NPI: 1366026353
Provider Name (Legal Business Name): KUNAL BONDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2021
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 S ORANGE AVE
NEWARK NJ
07103-2757
US

IV. Provider business mailing address

132 GESLER ST APT 3
PROVIDENCE RI
02909-1548
US

V. Phone/Fax

Practice location:
  • Phone: 401-543-9225
  • Fax:
Mailing address:
  • Phone: 401-543-9225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number25MA13037600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: