Healthcare Provider Details

I. General information

NPI: 1871667204
Provider Name (Legal Business Name): GURBIR S. KHERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2006
Last Update Date: 11/10/2023
Certification Date: 11/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 BRIAR HILL DR STE 4
MANALAPAN NJ
07726-3021
US

IV. Provider business mailing address

PO BOX 148
MANALAPAN NJ
07726-0148
US

V. Phone/Fax

Practice location:
  • Phone: 732-530-2900
  • Fax:
Mailing address:
  • Phone: 732-530-2900
  • Fax: 732-780-2804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMA04666000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: