Provider Demographics
NPI:1538146030
Name:KANSAGRA, CHUNILAL M (MD)
Entity Type:Individual
Prefix:MR
First Name:CHUNILAL
Middle Name:M
Last Name:KANSAGRA
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:PO BOX 106
Mailing Address - Street 2:51 DAVIS AVE
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07754-0106
Mailing Address - Country:US
Mailing Address - Phone:732-776-4339
Mailing Address - Fax:732-776-4544
Practice Address - Street 1:51 DAVIS AVE
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753
Practice Address - Country:US
Practice Address - Phone:732-776-4339
Practice Address - Fax:732-776-4544
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA309732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ223471515OtherAETNA
NJ450713OtherMEDICARE
NJ4611608Medicaid
NJ4611608Medicaid
NJ$$$$$$$$$OtherBCBS