Provider Demographics
NPI:1043436348
Name:KALRA, RITESH (MD)
Entity Type:Individual
Prefix:DR
First Name:RITESH
Middle Name:
Last Name:KALRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 CREEKSIDE CT
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-3750
Mailing Address - Country:US
Mailing Address - Phone:201-210-2186
Mailing Address - Fax:
Practice Address - Street 1:15-01 BROADWAY STE 8
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-6018
Practice Address - Country:US
Practice Address - Phone:201-796-8060
Practice Address - Fax:201-796-8070
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243355207R00000X
NJ25MA08381300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0238813Medicaid
NY1043436348OtherHORIZEN BLUE CROSS BLUE SHEILD
NJ0238813Medicaid