Healthcare Provider Details

I. General information

NPI: 1710931498
Provider Name (Legal Business Name): SUKHJENDER S GORAYA M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 ROOSEVELT AVE
CARTERET NJ
07008-2935
US

IV. Provider business mailing address

PO BOX 428
CARTERET NJ
07008-0428
US

V. Phone/Fax

Practice location:
  • Phone: 732-541-6521
  • Fax:
Mailing address:
  • Phone: 732-541-6521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberMA066839
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA066839
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: