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General NPI Number Information
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NPI Number | 1639499023
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Entity Type | Individual
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Provider Name | MITUL KANZARIA MD
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Gender | Male
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Dates
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Enumeration Date | 06/08/2010
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 1016 TACOMA AVE
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City | SUNNYSIDE
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State | WA
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Zip | 98944-2263
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Country | US
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Telephone | 509-837-1500
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Fax | 509-837-4908
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Provider Business Mailing Address
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Address Line | 2500 ENGLISH CREEK AVE SUITE 602
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City | EGG HARBOR TOWNSHIP
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State | NJ
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Zip | 08234
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Country | US
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Telephone | 609-407-2337
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 25MA10166600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | MD61239644
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License Number State | WA
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