Provider Demographics
NPI:1417980053
Name:KEDAR A. GOKHALE, M.D., LLC
Entity Type:Organization
Organization Name:KEDAR A. GOKHALE, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KEDAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOKHALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:201-666-6767
Mailing Address - Street 1:98 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HILLSDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07642-2716
Mailing Address - Country:US
Mailing Address - Phone:201-666-6767
Mailing Address - Fax:201-666-9599
Practice Address - Street 1:98 BROADWAY
Practice Address - Street 2:
Practice Address - City:HILLSDALE
Practice Address - State:NJ
Practice Address - Zip Code:07642-2716
Practice Address - Country:US
Practice Address - Phone:201-666-6767
Practice Address - Fax:201-666-9599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA063997207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJF87693Medicare UPIN
NJ096940Medicare ID - Type UnspecifiedPIN/GROUP ACCOUNT