Healthcare Provider Details

I. General information

NPI: 1912167701
Provider Name (Legal Business Name): RITU KHULLAR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2008
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:
Title or Position:
Credential:
Phone: