Provider Demographics
NPI:1609891415
Name:KHETERPAL, NEIL M (DO)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:M
Last Name:KHETERPAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:452 OLD HOOK RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:EMERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07630-1381
Mailing Address - Country:US
Mailing Address - Phone:201-666-3900
Mailing Address - Fax:201-261-0505
Practice Address - Street 1:20 PROSPECT AVE
Practice Address - Street 2:SUITE 715
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1997
Practice Address - Country:US
Practice Address - Phone:201-881-0721
Practice Address - Fax:201-881-0725
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY270700207RG0100X
NJ25MB08320000207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MB08320000OtherNJ MEDICAL LICENSE
NY03647014Medicaid
NJ25MB08320000OtherNJ MEDICAL LICENSE
NY03647014Medicaid