Provider Demographics
NPI:1154144285
Name:KALPTIRTH11 LLC
Entity type:Organization
Organization Name:KALPTIRTH11 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DHARIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN,FNP-BC
Authorized Official - Phone:609-553-1969
Mailing Address - Street 1:411 EBONY TREE AVE
Mailing Address - Street 2:
Mailing Address - City:GALLOWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08205-4429
Mailing Address - Country:US
Mailing Address - Phone:609-553-1969
Mailing Address - Fax:609-241-0608
Practice Address - Street 1:411 EBONY TREE AVE
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-4429
Practice Address - Country:US
Practice Address - Phone:609-553-1969
Practice Address - Fax:609-241-0608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-06
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty