Provider Demographics
NPI:1053669176
Name:PANDIT, TRUPTI
Entity Type:Individual
Prefix:
First Name:TRUPTI
Middle Name:
Last Name:PANDIT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRUPTI
Other - Middle Name:
Other - Last Name:KALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:302-651-4200
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:1505 W SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-7059
Practice Address - Country:US
Practice Address - Phone:856-845-0100
Practice Address - Fax:302-651-4945
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0361291572080A0000X
PAMD454718208000000X
NJ25MA10760600208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103004777Medicaid