Provider Demographics
NPI:1184064347
Name:GOSALIA, TANMAY PRADIP (DO, MPH, MA)
Entity type:Individual
Prefix:
First Name:TANMAY
Middle Name:PRADIP
Last Name:GOSALIA
Suffix:
Gender:M
Credentials:DO, MPH, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9225 JOHN F. KENNEDY BLVD
Mailing Address - Street 2:SUMMIT MEDICAL ARTS
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047
Mailing Address - Country:US
Mailing Address - Phone:201-453-2800
Mailing Address - Fax:
Practice Address - Street 1:9225 JOHN F KENNEDY BOULEVARD
Practice Address - Street 2:SUMMIT MEDICAL ARTS
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047
Practice Address - Country:US
Practice Address - Phone:201-453-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2017-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ194267207R00000X
NJ26MB09814100208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist