Healthcare Provider Details

I. General information

NPI: 1730112012
Provider Name (Legal Business Name): KATHIRGAMATHAS KURUNATHAPILLAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

886 BELMONT AVE UNIT C2
NORTH HALEDON NJ
07508-2573
US

IV. Provider business mailing address

PO BOX 425
MAHWAH NJ
07430-0425
US

V. Phone/Fax

Practice location:
  • Phone: 973-333-5857
  • Fax: 201-465-3225
Mailing address:
  • Phone: 845-901-7487
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA08812800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: