MEDICARE: DR. SHANTI DHUPAR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	25MAO31548	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346242815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANTI DHUPAR M.D.

Provider Business Mailing Address
First Line	:	501 NORTH AVE
Second Line	:
City	:	WOOD-RIDGE
State	:	NJ
Zip	:	07075-2334
Country	:	US
Telephone Number	:	201-460-9362
Fax Number	:	201-460-0258

Provider Business Practice Location Address
First Line	:	501 NORTH AVE
Second Line	:
City	:	WOOD-RIDGE
State	:	NJ
Zip	:	07075-2334
Country	:	US
Telephone Number	:	201-460-9362
Fax Number	:	201-460-0258

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	08/12/2011

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