Provider Demographics
NPI:1659460012
Name:KAISTHA, ARUN K (OD)
Entity Type:Individual
Prefix:DR
First Name:ARUN
Middle Name:K
Last Name:KAISTHA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 S WHITE HORSE PIKE
Mailing Address - Street 2:SUITE B2
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-1804
Mailing Address - Country:US
Mailing Address - Phone:609-567-0997
Mailing Address - Fax:609-567-0515
Practice Address - Street 1:120 S WHITE HORSE PIKE
Practice Address - Street 2:SUITE B2
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-1804
Practice Address - Country:US
Practice Address - Phone:609-567-0997
Practice Address - Fax:609-567-0515
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ270A00591800152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1659460012OtherNPI 1659460012
U97150Medicare UPIN
095645Medicare PIN