Provider Demographics
NPI:1114106176
Name:TUSHARKUMAR N MISTRY MD LLC
Entity Type:Organization
Organization Name:TUSHARKUMAR N MISTRY MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TUSHARKUMAR
Authorized Official - Middle Name:N
Authorized Official - Last Name:MISTRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-679-4200
Mailing Address - Street 1:28 THROCKMORTON LN
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2558
Mailing Address - Country:US
Mailing Address - Phone:732-679-4200
Mailing Address - Fax:
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:732-851-4632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07930800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0075850Medicaid
NJ0075850Medicaid