Healthcare Provider Details

I. General information

NPI: 1275704926
Provider Name (Legal Business Name): RUPA MAHENDRA KHANDWALA P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 ROUTE 516
OLD BRIDGE NJ
08857-1402
US

IV. Provider business mailing address

15 RAINTREE CT
HOLMDEL NJ
07733-2814
US

V. Phone/Fax

Practice location:
  • Phone: 973-865-6577
  • Fax:
Mailing address:
  • Phone: 732-887-5598
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number25MP00195800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number013812
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: