Provider Demographics
NPI:1275700809
Name:KOKILA CHANDARANA, M.D; PA
Entity Type:Organization
Organization Name:KOKILA CHANDARANA, M.D; PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KOKILA
Authorized Official - Middle Name:SHASHIKANT
Authorized Official - Last Name:CHANDARANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:908-580-1025
Mailing Address - Street 1:24 NOTTINGHAM WAY
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-6753
Mailing Address - Country:US
Mailing Address - Phone:908-580-1025
Mailing Address - Fax:908-548-0849
Practice Address - Street 1:140 PARK AVE
Practice Address - Street 2:WINDSOR GARDEN CARE CENTER
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-5248
Practice Address - Country:US
Practice Address - Phone:973-677-1500
Practice Address - Fax:973-675-0512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03070600208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3086704Medicaid
NJC56285Medicare UPIN
NJ3086704Medicaid