Healthcare Provider Details

I. General information

NPI: 1407879000
Provider Name (Legal Business Name): GAUTAM MALHOTRA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 COLUMBIA TPKE STE 102B
FLORHAM PARK NJ
07932-2193
US

IV. Provider business mailing address

9 CAIN CIR
WATCHUNG NJ
07069-6256
US

V. Phone/Fax

Practice location:
  • Phone: 973-755-0190
  • Fax: 973-755-0191
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License Number25MA07676200
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code204R00000X
TaxonomyElectrodiagnostic Medicine Physician
License Number25MA07676200
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number25MA07676200
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number25MA07676200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: