Individual
MIRA CHAKRAVARTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3840 PARK AVENUE, SUITE C, EDISON, NJ 08820
(732) 494-9061
(732) 494-5571
Mailing address
3840 PARK AVE, SUITE C, EDISON, NJ 08820-2563
(732) 494-9061
(732) 494-5571
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
25MA03783000
NJ
Other
Enumeration date
06/25/2007
Last updated
02/05/2014
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