Provider Demographics
NPI:1073868873
Name:GOSALIA, KINJAL AMIT (STUDENT)
Entity Type:Individual
Prefix:
First Name:KINJAL
Middle Name:AMIT
Last Name:GOSALIA
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RESEARCH RD
Mailing Address - Street 2:
Mailing Address - City:RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:11961-2701
Mailing Address - Country:US
Mailing Address - Phone:631-751-3000
Mailing Address - Fax:
Practice Address - Street 1:5316 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-2591
Practice Address - Country:US
Practice Address - Phone:631-758-7003
Practice Address - Fax:631-751-0506
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-17
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY280391207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology