Healthcare Provider Details

I. General information

NPI: 1356382600
Provider Name (Legal Business Name): PRITI S GUJAR M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 09/16/2021
Certification Date: 09/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 FRANKLIN CORNER RD STE 204
LAWRENCE TOWNSHIP NJ
08648-2526
US

IV. Provider business mailing address

12 BAILEY DR
PRINCETON NJ
08540-7955
US

V. Phone/Fax

Practice location:
  • Phone: 609-730-1888
  • Fax: 609-730-1818
Mailing address:
  • Phone: 609-730-1888
  • Fax: 609-730-1818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number25MA07953700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: