Healthcare Provider Details

I. General information

NPI: 1104368208
Provider Name (Legal Business Name): GOLDSTAR PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2016
Last Update Date: 04/04/2023
Certification Date: 04/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 PROFESSIONAL CIR STE 103
COLTS NECK NJ
07722-2427
US

IV. Provider business mailing address

9 PROFESSIONAL CIR STE 103N
COLTS NECK NJ
07722-2427
US

V. Phone/Fax

Practice location:
  • Phone: 848-300-0010
  • Fax: 732-440-3737
Mailing address:
  • Phone: 848-300-0010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA08909400
License Number StateNJ

VIII. Authorized Official

Name: RITU KHULLAR
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 609-457-5941