Healthcare Provider Details

I. General information

NPI: 1912958521
Provider Name (Legal Business Name): SURENDRA P GOEL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 MOUNTAIN AVE
HAWTHORNE NJ
07506-3331
US

IV. Provider business mailing address

159 MOUNTAIN AVE
HAWTHORNE NJ
07506-3331
US

V. Phone/Fax

Practice location:
  • Phone: 973-557-6731
  • Fax:
Mailing address:
  • Phone: 973-557-6731
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA03047300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: