Provider Demographics
NPI:1285165431
Name:SITAPARA, KISHAN ARVIND (MD)
Entity type:Individual
Prefix:DR
First Name:KISHAN
Middle Name:ARVIND
Last Name:SITAPARA
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 1:720 MONROE ST STE C208
Mailing Address - Street 2:
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6350
Mailing Address - Country:US
Mailing Address - Phone:201-533-9200
Mailing Address - Fax:
Practice Address - Street 1:720 MONROE ST STE C208
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-6350
Practice Address - Country:US
Practice Address - Phone:201-533-9200
Practice Address - Fax:201-533-9299
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NJ25MA11448400208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program