Provider Demographics
NPI:1396732491
Name:ATHWAL, HARJIT S (MD)
Entity type:Individual
Prefix:DR
First Name:HARJIT
Middle Name:S
Last Name:ATHWAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MULE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5028
Mailing Address - Country:US
Mailing Address - Phone:732-286-0900
Mailing Address - Fax:732-244-6063
Practice Address - Street 1:14 MULE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5028
Practice Address - Country:US
Practice Address - Phone:732-286-0900
Practice Address - Fax:732-244-6063
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05179600207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5044405Medicaid
NJ5044405Medicaid
NJ600650BCRMedicare ID - Type Unspecified