Provider Demographics
NPI:1053302976
Name:MISTRY, TUSHARKUMAR N (MD)
Entity Type:Individual
Prefix:DR
First Name:TUSHARKUMAR
Middle Name:N
Last Name:MISTRY
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 1:8 COUNTY ROAD 520 STE A
Mailing Address - Street 2:
Mailing Address - City:ENGLISHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8478
Mailing Address - Country:US
Mailing Address - Phone:732-679-4200
Mailing Address - Fax:732-851-4532
Practice Address - Street 1:8 COUNTY ROAD 520 STE A
Practice Address - Street 2:
Practice Address - City:ENGLISHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8478
Practice Address - Country:US
Practice Address - Phone:732-679-4200
Practice Address - Fax:732-851-4532
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07930800208D00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0075850Medicaid
NJI39199Medicare UPIN
NJ100098Medicare ID - Type Unspecified