Provider Demographics
NPI:1699228296
Name:GOPALAKRISHNAMOORTHY, MAHALAKSHMI (MD)
Entity Type:Individual
Prefix:DR
First Name:MAHALAKSHMI
Middle Name:
Last Name:GOPALAKRISHNAMOORTHY
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 1:229 ENGLE ST
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-2409
Mailing Address - Country:US
Mailing Address - Phone:201-567-8999
Mailing Address - Fax:
Practice Address - Street 1:229 ENGLE ST
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2409
Practice Address - Country:US
Practice Address - Phone:201-567-8999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299522-012080P0205X
NJ25MA115467002080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology