Provider Demographics
NPI:1386615284
Name:GOVIL, SUSHAMA C (MD)
Entity type:Individual
Prefix:
First Name:SUSHAMA
Middle Name:C
Last Name:GOVIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 W PARSONAGE WAY
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-7903
Mailing Address - Country:US
Mailing Address - Phone:732-776-4143
Mailing Address - Fax:732-776-4146
Practice Address - Street 1:1945 ROUTE 33
Practice Address - Street 2:JERSEY SHORE UNIVERSITY MEDICAL CENTER
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07754
Practice Address - Country:US
Practice Address - Phone:732-776-4143
Practice Address - Fax:732-776-4146
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02774500207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJG80824Medicare UPIN
NJ019960Medicare ID - Type Unspecified