Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | MA32098 | NJ |
N | 207RX0202X | Medical Oncology | MA32098 | NJ |
NPI | 1063551687 |
---|---|
Provider Name | Dr. Pradeep S. Mahal |
First Address | Union, NJ 07083-3331 |
Second Address | Union, NJ 07083-3331 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/02/2007 |
Last Update Date | 21/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0671606 | (05) | NJ |
C54148 | (02) | NJ |