Provider Demographics
NPI:1821417098
Name:MERCHANT, KUNAL YATISH (MD)
Entity type:Individual
Prefix:
First Name:KUNAL
Middle Name:YATISH
Last Name:MERCHANT
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 1:243 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-3002
Mailing Address - Country:US
Mailing Address - Phone:617-573-4443
Mailing Address - Fax:
Practice Address - Street 1:65 HARRISTOWN RD STE 302
Practice Address - Street 2:
Practice Address - City:GLEN ROCK
Practice Address - State:NJ
Practice Address - Zip Code:07452-3317
Practice Address - Country:US
Practice Address - Phone:201-797-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA274414207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology