Provider Demographics
NPI:1225362361
Name:RUPA J PANCHAL MD PC
Entity Type:Organization
Organization Name:RUPA J PANCHAL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RUPA
Authorized Official - Middle Name:J
Authorized Official - Last Name:PANCHAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-801-7502
Mailing Address - Street 1:5 ELKRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-3179
Mailing Address - Country:US
Mailing Address - Phone:732-801-7502
Mailing Address - Fax:732-317-9302
Practice Address - Street 1:3 HOSPITAL PLZ
Practice Address - Street 2:SUITE 206
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-3093
Practice Address - Country:US
Practice Address - Phone:732-801-7502
Practice Address - Fax:732-317-9302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-22
Last Update Date:2009-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07606800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0037486Medicaid
NJ077802Medicare PIN
NJH31217Medicare UPIN