Provider Demographics
NPI:1902388960
Name:RGOHEL LLC
Entity Type:Organization
Organization Name:RGOHEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REKHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOHEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-409-6440
Mailing Address - Street 1:26 MOLLY PITCHER DR
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8937
Mailing Address - Country:US
Mailing Address - Phone:732-409-6440
Mailing Address - Fax:732-409-6466
Practice Address - Street 1:318 PROFESSIONAL VIEW DR
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-7904
Practice Address - Country:US
Practice Address - Phone:732-409-6440
Practice Address - Fax:732-409-6466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-05
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07451500207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA07451500OtherSTATE LICENCE