Provider Demographics
NPI:1770646267
Name:KONDA, KALPANA (MD)
Entity Type:Individual
Prefix:
First Name:KALPANA
Middle Name:
Last Name:KONDA
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:PO BOX 48270
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-4800
Mailing Address - Country:US
Mailing Address - Phone:201-818-9118
Mailing Address - Fax:
Practice Address - Street 1:530 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3654
Practice Address - Country:US
Practice Address - Phone:732-293-2316
Practice Address - Fax:732-324-3320
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03869800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2834633000OtherAMERIHEALTH #
NJ1581046OtherAETNA HMO #
NJ01007828800OtherAMERICHOICE
NJ322286OtherAMERIGROUP
NJ3K4836OtherHEALTHNET #
NJ7450960OtherAETNA PPO #
NJ60031773OtherHORIZON NJ HEALTH #