Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | MA06053800 | NJ |
NPI | 1104849181 |
---|---|
Provider Name | Dr. Medha Gavai |
First Address | Highland Park, NJ 08904-1817 |
Second Address | Highland Park, NJ 08904-1817 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/07/2006 |
Last Update Date | 08/07/2007 |