1194042317 NPI number — DR. RUPA GOPALAN JUTHANI M.D.

Table of content: DR. RUPA GOPALAN JUTHANI M.D. (NPI 1194042317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194042317 NPI number — DR. RUPA GOPALAN JUTHANI M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JUTHANI
Provider First Name:
RUPA
Provider Middle Name:
GOPALAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GOPALAN
Provider Other First Name:
RUPA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194042317
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1200 E RIDGEWOOD AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
RIDGEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07450
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-327-8600
Provider Business Mailing Address Fax Number:
201-327-8225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NEUROSURGICAL ASSOCIATES OF NEW JERSEY, P.C.
Provider Second Line Business Practice Location Address:
1200 E RIDGEWOOD AVENUE STE 200
Provider Business Practice Location Address City Name:
RIDGEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07450
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-327-8600
Provider Business Practice Location Address Fax Number:
201-327-8225
Provider Enumeration Date:
04/27/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  289606 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207T00000X , with the licence number: 25MA11504900 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)