Provider Demographics
NPI:1386128403
Name:MEKHALA MATHURE MD LLC
Entity type:Organization
Organization Name:MEKHALA MATHURE MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED INTERNAL MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:MEKHALA
Authorized Official - Middle Name:ASHOK
Authorized Official - Last Name:MATHURE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-553-1903
Mailing Address - Street 1:1145 BORDENTOWN AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-1851
Mailing Address - Country:US
Mailing Address - Phone:732-553-1901
Mailing Address - Fax:
Practice Address - Street 1:1145 BORDENTOWN AVE STE 4
Practice Address - Street 2:
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859-1851
Practice Address - Country:US
Practice Address - Phone:732-553-1901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-25
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty