Provider Demographics
NPI:1376619353
Name:KALIA-SHARMA, AMITA (MD)
Entity Type:Individual
Prefix:DR
First Name:AMITA
Middle Name:
Last Name:KALIA-SHARMA
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 1:1124 E. RIDGEWOOD AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450
Mailing Address - Country:US
Mailing Address - Phone:201-652-8585
Mailing Address - Fax:201-612-1439
Practice Address - Street 1:1124 E RIDGEWOOD AVE STE 103
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3915
Practice Address - Country:US
Practice Address - Phone:201-652-8585
Practice Address - Fax:201-612-1439
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MAO6929900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0036196Medicaid
NJ081317Medicare ID - Type Unspecified
NJI11631Medicare UPIN