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General NPI Number Information
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NPI Number | 1790678753
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Entity Type | Organization
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Legal Business Name | MIND AND BODY MEDICINE LLC
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Dates
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Enumeration Date | 05/29/2025
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Last Update Date | 05/29/2025
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Provider Practice Location Address
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Address Line | 28 SAINT MORITZ LN
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City | CHERRY HILL
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State | NJ
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Zip | 08003-5122
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Country | US
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Telephone | 732-659-1051
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Fax |
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Provider Business Mailing Address
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Address Line | 28 SAINT MORITZ LN
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City | CHERRY HILL
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State | NJ
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Zip | 08003-5122
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Country | US
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Telephone | 732-659-1051
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KARUNA S PODDAR
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Credential | MD
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Telephone | 732-659-1051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number |
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License Number State |
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