Provider Demographics
NPI:1184649311
Name:DALAL, GITA (MD)
Entity Type:Individual
Prefix:DR
First Name:GITA
Middle Name:
Last Name:DALAL
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 1:49 ROXY AVE
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1641
Mailing Address - Country:US
Mailing Address - Phone:732-574-2796
Mailing Address - Fax:732-574-2798
Practice Address - Street 1:16 ETHEL RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-2249
Practice Address - Country:US
Practice Address - Phone:732-248-0088
Practice Address - Fax:732-248-4405
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMAO38240207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMAO38240OtherLICENSE
NJ71918Medicare UPIN