Provider Demographics
NPI:1275607897
Name:GOPAL, INDU (MD)
Entity Type:Individual
Prefix:
First Name:INDU
Middle Name:
Last Name:GOPAL
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 1:515 IRONBRIDGE ROAD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728
Mailing Address - Country:US
Mailing Address - Phone:732-294-9922
Mailing Address - Fax:732-294-9986
Practice Address - Street 1:515 IRONBRIDGE ROAD
Practice Address - Street 2:SUITE 2
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728
Practice Address - Country:US
Practice Address - Phone:732-294-9922
Practice Address - Fax:732-294-9986
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA41868207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5553601Medicaid
NJ152373Medicare ID - Type Unspecified
NJ5553601Medicaid