Healthcare Provider Details

I. General information

NPI: 1265424238
Provider Name (Legal Business Name): SAVITA KHOSLA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 06/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 SUMMIT AVE
HACKENSACK NJ
07601-1263
US

IV. Provider business mailing address

58 SUMMIT AVE
HACKENSACK NJ
07601-1263
US

V. Phone/Fax

Practice location:
  • Phone: 201-489-2255
  • Fax: 201-489-4799
Mailing address:
  • Phone: 201-489-2255
  • Fax: 201-489-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number25MA04219700
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier4219150
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerAETNA PPO
# 2
Identifier64D771
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerEMPIRE BCBS HACKENSACK
# 3
IdentifierBP438
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerOXFORD
# 4
Identifier047GU1
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerEMPIRE BCBS RIDGEWOOD
# 5
Identifier64D773
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerEMPIRE BCBS MAHWAH
# 6
Identifier0298785
Identifier TypeOTHER
Identifier StateNJ
Identifier IssuerGHI PPO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: