Provider Demographics
NPI:1689624173
Name:GOPAL, LEKHA (MD)
Entity Type:Individual
Prefix:DR
First Name:LEKHA
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 1:806 KEARNY AVE
Mailing Address - Street 2:
Mailing Address - City:KEARNY
Mailing Address - State:NJ
Mailing Address - Zip Code:07032-3148
Mailing Address - Country:US
Mailing Address - Phone:201-991-6900
Mailing Address - Fax:201-991-6997
Practice Address - Street 1:806 KEARNY AVE
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-3148
Practice Address - Country:US
Practice Address - Phone:201-991-6900
Practice Address - Fax:201-991-6997
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA07246700207W00000X
NY218774207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H38910Medicare UPIN
NJ0044849Medicare ID - Type Unspecified
NJ084849A6YMedicare ID - Type Unspecified