Healthcare Provider Details

I. General information

NPI: 1801449897
Provider Name (Legal Business Name): MASHRUTEE MAHARAUL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ENGLISH CREEK AVE STE 800
EGG HARBOR TOWNSHIP NJ
08234-5500
US

IV. Provider business mailing address

2500 ENGLISH CREEK AVE STE 800
EGG HARBOR TOWNSHIP NJ
08234-5500
US

V. Phone/Fax

Practice location:
  • Phone: 609-407-2277
  • Fax: 609-677-7280
Mailing address:
  • Phone: 609-407-2277
  • Fax: 609-677-7280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number25MA12147800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: