Provider Demographics
NPI:1578085502
Name:GHOTRA, SUKHWINDER S (CRNA)
Entity Type:Individual
Prefix:MR
First Name:SUKHWINDER
Middle Name:S
Last Name:GHOTRA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 BRUNO ST
Mailing Address - Street 2:
Mailing Address - City:MOONACHIE
Mailing Address - State:NJ
Mailing Address - Zip Code:07074-1132
Mailing Address - Country:US
Mailing Address - Phone:201-575-6484
Mailing Address - Fax:
Practice Address - Street 1:355 GRAND ST
Practice Address - Street 2:
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07302-4321
Practice Address - Country:US
Practice Address - Phone:201-915-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-12
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00743500367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered