Provider Demographics
NPI:1104368208
Name:GOLDSTAR PEDIATRICS, LLC
Entity Type:Organization
Organization Name:GOLDSTAR PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:RITU
Authorized Official - Middle Name:
Authorized Official - Last Name:KHULLAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:609-457-5941
Mailing Address - Street 1:9 PROFESSIONAL CIR STE 103N
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2427
Mailing Address - Country:US
Mailing Address - Phone:848-300-0010
Mailing Address - Fax:
Practice Address - Street 1:9 PROFESSIONAL CIR STE 103
Practice Address - Street 2:
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2427
Practice Address - Country:US
Practice Address - Phone:848-300-0010
Practice Address - Fax:732-440-3737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-07
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08909400208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA08909400OtherNJ LICENSE