Provider Demographics
NPI:1043517857
Name:KESPRA MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:KESPRA MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PULIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-243-9808
Mailing Address - Street 1:22 MERIDIAN RD UNIT 10
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-2848
Mailing Address - Country:US
Mailing Address - Phone:732-243-9808
Mailing Address - Fax:732-791-5765
Practice Address - Street 1:22, MERIDIAN RD UNIT 10
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3144
Practice Address - Country:US
Practice Address - Phone:732-243-9808
Practice Address - Fax:732-791-5765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-15
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08345000302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ121291NENMedicare PIN