=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912352642
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REKHA GOHEL MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2016
-----------------------------------------------------
Last Update Date | 05/02/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26 MOLLY PITCHER DR
-----------------------------------------------------
City | MANALAPAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07726-8937
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-822-7435
-----------------------------------------------------
Fax | 732-831-6117
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26 MOLLY PITCHER DR
-----------------------------------------------------
City | MANALAPAN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07726-8937
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-822-7435
-----------------------------------------------------
Fax | 732-831-6117
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. REKHA GOHEL
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 732-822-7435
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RA0000X
-----------------------------------------------------
Taxonomy Name | Adolescent Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 25MA07451500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number | 25MA07451500
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------