Provider Demographics
NPI:1518963412
Name:KUMAR, GUNJAN (PA,-C)
Entity type:Individual
Prefix:
First Name:GUNJAN
Middle Name:
Last Name:KUMAR
Suffix:
Gender:F
Credentials:PA,-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 MCBRIDE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-3806
Mailing Address - Country:US
Mailing Address - Phone:973-812-1400
Mailing Address - Fax:973-812-1404
Practice Address - Street 1:52 1ST ST
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-2044
Practice Address - Country:US
Practice Address - Phone:201-488-3003
Practice Address - Fax:201-488-6911
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00040900363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0546259Medicaid