Basic Information
| Provider Information | |||||||||
| NPI: | 1639499023 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KANZARIA | ||||||||
| FirstName: | MITUL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 ENGLISH CREEK AVE | ||||||||
| Address2: | SUITE 602 | ||||||||
| City: | EGG HARBOR TOWNSHIP | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 08234 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094072337 | ||||||||
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| Practice Location | |||||||||
| Address1: | 318 CHRIS GAUPP DR | ||||||||
| Address2: | |||||||||
| City: | GALLOWAY | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 082054460 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6094049900 | ||||||||
| FaxNumber: | 6094043653 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2010 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 25MA10166600 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.