MEDICARE: DR. NEETA MOTIWALA MD

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	207R00000X	Internal Medicine Physician	MA050979	NJ
2	207R00000X	Internal Medicine Physician	25MA05097900	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	31D0952983	OTHER	NJ	CLIA

General Provider Information

NPI Number	:	1538153531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEETA MOTIWALA MD

Provider Business Mailing Address
First Line	:	466 OLD HOOK ROAD
Second Line	:	SUITE 1
City	:	EMERSON
State	:	NJ
Zip	:	07630-1368
Country	:	US
Telephone Number	:	201-967-8221
Fax Number	:	201-634-9647

Provider Business Practice Location Address
First Line	:	466 OLD HOOK ROAD
Second Line	:	SUITE 1
City	:	EMERSON
State	:	NJ
Zip	:	07630-1368
Country	:	US
Telephone Number	:	201-967-8221
Fax Number	:	201-634-9647

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

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	12/27/2012

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