Provider Demographics
NPI:1871551721
Name:JOHAL, GURVINDRA SINGH (DO)
Entity type:Individual
Prefix:DR
First Name:GURVINDRA
Middle Name:SINGH
Last Name:JOHAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1813 OAK TREE ROAD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820
Mailing Address - Country:US
Mailing Address - Phone:908-769-9494
Mailing Address - Fax:908-755-3833
Practice Address - Street 1:1813 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820
Practice Address - Country:US
Practice Address - Phone:908-769-9494
Practice Address - Fax:908-755-3833
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20007934207P00000X
NJ25MB06533000207R00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000039666Medicaid
DE1000039666Medicaid
DE020803D18Medicare PIN