Provider Demographics
NPI:1285329730
Name:GOSWAMI, MINAL ANIL
Entity type:Individual
Prefix:
First Name:MINAL
Middle Name:ANIL
Last Name:GOSWAMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 WOODCLIFF BLVD
Mailing Address - Street 2:
Mailing Address - City:MORGANVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07751-4225
Mailing Address - Country:US
Mailing Address - Phone:347-759-3071
Mailing Address - Fax:
Practice Address - Street 1:2350 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:ALLENWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08720-7037
Practice Address - Country:US
Practice Address - Phone:732-683-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01666200225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist