Healthcare Provider Details

I. General information

NPI: 1497801740
Provider Name (Legal Business Name): GAUTAM SEHGAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 07/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 S ORANGE AVE
SOUTH ORANGE NJ
07079-2202
US

IV. Provider business mailing address

228 S ORANGE AVE
SOUTH ORANGE NJ
07079-2202
US

V. Phone/Fax

Practice location:
  • Phone: 973-761-4455
  • Fax: 973-761-4899
Mailing address:
  • Phone: 973-761-4455
  • Fax: 973-761-4899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License NumberMA032152
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: