Provider Demographics
NPI:1033207410
Name:MAUN, DIMPLE CHAMPAKLAL (MD)
Entity Type:Individual
Prefix:DR
First Name:DIMPLE
Middle Name:CHAMPAKLAL
Last Name:MAUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:809 SUN VALLEY WAY
Mailing Address - Street 2:
Mailing Address - City:FLORHAM PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07932-3007
Mailing Address - Country:US
Mailing Address - Phone:347-439-3413
Mailing Address - Fax:
Practice Address - Street 1:369 W BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NJ
Practice Address - Zip Code:07801-2560
Practice Address - Country:US
Practice Address - Phone:973-328-8300
Practice Address - Fax:866-811-0251
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ082118208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0141291Medicaid