Provider Demographics
NPI:1538665245
Name:SHUKLA, KUSHAL (MD)
Entity Type:Individual
Prefix:DR
First Name:KUSHAL
Middle Name:
Last Name:SHUKLA
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 1:1213 FRANCYNE WAY
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-5818
Mailing Address - Country:US
Mailing Address - Phone:973-597-8425
Mailing Address - Fax:
Practice Address - Street 1:613 PARK AVE FL 2
Practice Address - Street 2:
Practice Address - City:EAST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07017-1905
Practice Address - Country:US
Practice Address - Phone:973-672-8573
Practice Address - Fax:973-766-8099
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA11245100207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine