Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 25MA07600700 | NJ |
NPI | 1003911280 |
---|---|
Provider Name | Hetal Gor |
First Address | Tenafly, NJ 07670-1454 |
Second Address | Englewood, NJ 07631-3578 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 25/04/2008 |