Individual
MIRA UPADHYAYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., M.P.H.
Contact information
Practice address
22-18 BROADWAY, FAIR LAWN, NJ 07410-3016
(973) 321-2755
Mailing address
22-18 BROADWAY, FAIR LAWN, NJ 07410-3016
(201) 475-5050
(201) 475-5522
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
25MA10880000
NJ
207RA0401X
Addiction Medicine (Internal Medicine) Physician
25MA10880000
NJ
Other
Enumeration date
06/27/2016
Last updated
02/25/2021
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