MEDICARE: DR. VISHWALA KASBEKAR 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	207R00000X	Internal Medicine Physician	279479	NY
2	208000000X	Pediatrics Physician	279479	NY
3	207R00000X	Internal Medicine Physician	25MA12050600	NJ

General Provider Information

NPI Number	:	1649539180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VISHWALA KASBEKAR M.D.

Provider Business Mailing Address
First Line	:	PO BOX 416457
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02241-6457
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	46 NEWMAN SPRINGS RD E STE D
Second Line	:
City	:	RED BANK
State	:	NJ
Zip	:	07701-1531
Country	:	US
Telephone Number	:	732-945-0965
Fax Number	:	732-945-0966

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

Provider Enumeration Date	:	05/03/2012
Last Update Date	:	03/18/2024

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