Healthcare Provider Details

I. General information

NPI: 1568374411
Provider Name (Legal Business Name): UDAY CHINAIWALA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

85 OLD PROSPECT SCHOOL RD
SPARTA NJ
07871-3317
US

IV. Provider business mailing address

85 OLD PROSPECT SCHOOL RD
SPARTA NJ
07871-3317
US

V. Phone/Fax

Practice location:
  • Phone: 609-602-9782
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37AC00997700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: