Healthcare Provider Details

I. General information

NPI: 1992732135
Provider Name (Legal Business Name): KAVITA K BUPATHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 WOODBRIDGE CENTER SUITE 405
WOODBRIDGE NJ
07095
US

IV. Provider business mailing address

1 WOODBRIDGE CENTER SUITE #405
WOODBRIDGE NJ
07095
US

V. Phone/Fax

Practice location:
  • Phone: 732-650-0350
  • Fax: 732-650-0354
Mailing address:
  • Phone: 732-326-0363
  • Fax: 732-326-0365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMAO69857
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: