Provider Demographics
NPI:1114067527
Name:KOUL, MRINAL (MD)
Entity Type:Individual
Prefix:
First Name:MRINAL
Middle Name:
Last Name:KOUL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5604
Mailing Address - Street 2:
Mailing Address - City:CLARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07066-5604
Mailing Address - Country:US
Mailing Address - Phone:908-490-0036
Mailing Address - Fax:908-490-0067
Practice Address - Street 1:341 WALNUT ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-2611
Practice Address - Country:US
Practice Address - Phone:908-490-0036
Practice Address - Fax:908-490-0067
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07786800207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology