Provider Demographics
NPI:1073701819
Name:KADAKIA, PARUL M (PA)
Entity Type:Individual
Prefix:MRS
First Name:PARUL
Middle Name:M
Last Name:KADAKIA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 CORLIES AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-6116
Mailing Address - Country:US
Mailing Address - Phone:732-263-7960
Mailing Address - Fax:
Practice Address - Street 1:2100 CORLIES AVE STE 12
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-6116
Practice Address - Country:US
Practice Address - Phone:732-263-7960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012282363AM0700X
NYP61126363AS0400X
NJ25MP00263500363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6510IHMedicare PIN