Provider Demographics
NPI:1235169202
Name:GINWALA, KHATOON T (MD)
Entity Type:Individual
Prefix:
First Name:KHATOON
Middle Name:T
Last Name:GINWALA
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 1:5045 ROUTE 130
Mailing Address - Street 2:SUITE I
Mailing Address - City:DELRAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08075-9707
Mailing Address - Country:US
Mailing Address - Phone:856-764-7660
Mailing Address - Fax:856-764-5723
Practice Address - Street 1:5045 ROUTE 130
Practice Address - Street 2:SUITE I
Practice Address - City:DELRAN
Practice Address - State:NJ
Practice Address - Zip Code:08075-9707
Practice Address - Country:US
Practice Address - Phone:856-764-7660
Practice Address - Fax:856-764-5723
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA34108207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3721302Medicaid
C54609Medicare UPIN
NJ442720Medicare ID - Type Unspecified