Provider Demographics
NPI:1063551687
Name:MAHAL, PRADEEP S (MD)
Entity type:Individual
Prefix:DR
First Name:PRADEEP
Middle Name:S
Last Name:MAHAL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1308 MORRIS AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-3331
Mailing Address - Country:US
Mailing Address - Phone:908-851-6767
Mailing Address - Fax:908-851-0382
Practice Address - Street 1:1308 MORRIS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-3331
Practice Address - Country:US
Practice Address - Phone:908-851-6767
Practice Address - Fax:908-851-0382
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2010-06-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJMA32098207RG0100X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0671606Medicaid
NJC54148Medicare UPIN
NJ0671606Medicaid