Provider Demographics
NPI:1306617063
Name:KAVITA BUPATHI MD LLC
Entity type:Organization
Organization Name:KAVITA BUPATHI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KISHOR
Authorized Official - Middle Name:
Authorized Official - Last Name:BUPATHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:908-456-0083
Mailing Address - Street 1:2 ETHEL RD STE 206B
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08817-2839
Mailing Address - Country:US
Mailing Address - Phone:732-650-0350
Mailing Address - Fax:732-650-0351
Practice Address - Street 1:1000 WOODBRIDGE CENTER DR STE 106
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-1315
Practice Address - Country:US
Practice Address - Phone:732-326-0363
Practice Address - Fax:732-326-0364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty