Healthcare Provider Details

I. General information

NPI: 1952419871
Provider Name (Legal Business Name): GURVINDRA SINGH JOHAL DO PA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 OAK TREE RD
EDISON NJ
08820-2740
US

IV. Provider business mailing address

1813 OAK TREE RD
EDISON NJ
08820-2740
US

V. Phone/Fax

Practice location:
  • Phone: 908-769-9494
  • Fax: 908-755-3833
Mailing address:
  • Phone: 908-769-9494
  • Fax: 908-755-3833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MBO6533000
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MAO4637200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMAO4582200
License Number StateNJ

VIII. Authorized Official

Name: BINITA PATEL
Title or Position: BILLING MANAGER
Credential:
Phone: 732-290-1014