MEDICARE: DR. GAUTAM MALHOTRA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	25MA07676200	NJ

General Provider Information

NPI Number	:	1407879000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAUTAM MALHOTRA M.D.

Provider Business Mailing Address
First Line	:	9 CAIN CIR
Second Line	:
City	:	WATCHUNG
State	:	NJ
Zip	:	07069-6256
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 MADISON AVE STE 300
Second Line	:
City	:	MORRISTOWN
State	:	NJ
Zip	:	07960-6967
Country	:	US
Telephone Number	:	973-206-1477
Fax Number	:	973-695-1322

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	02/20/2024

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