Provider Demographics
NPI:1346242815
Name:DHUPAR, SHANTI (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANTI
Middle Name:
Last Name:DHUPAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WOOD-RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-2334
Mailing Address - Country:US
Mailing Address - Phone:201-460-9362
Mailing Address - Fax:201-460-0258
Practice Address - Street 1:501 NORTH AVE
Practice Address - Street 2:
Practice Address - City:WOOD-RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07075-2334
Practice Address - Country:US
Practice Address - Phone:201-460-9362
Practice Address - Fax:201-460-0258
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO315482080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ377450301Medicaid
NJC50103Medicare UPIN