Provider Demographics
NPI:1275786089
Name:KAMDAR, MEHUL RAJNIKANT (MD)
Entity Type:Individual
Prefix:
First Name:MEHUL
Middle Name:RAJNIKANT
Last Name:KAMDAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 JAMES STREET
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6136
Mailing Address - Country:US
Mailing Address - Phone:917-656-1977
Mailing Address - Fax:973-577-6049
Practice Address - Street 1:261 JAMES STREET
Practice Address - Street 2:SUITE 1B
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:917-656-1977
Practice Address - Fax:973-577-6049
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2021-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237991208200000X
NJ25MA08778700208200000X
CAA108348208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ208269OtherMEDICARE PTAN
CA00A1083480Medicaid
NJ208269OtherMEDICARE PTAN