Basic Information
| Provider Information | |||||||||
| NPI: | 1003804964 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHAROD | ||||||||
| FirstName: | AMIT | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 W MAIN ST | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | FREEHOLD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077282537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323084202 | ||||||||
| FaxNumber: | 7323084212 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 W MAIN ST | ||||||||
| Address2: | SUITE 107 | ||||||||
| City: | FREEHOLD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077282537 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323084202 | ||||||||
| FaxNumber: | 7323084212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2005 | ||||||||
| LastUpdateDate: | 01/27/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD068352L | PA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 25MA08240200 | NJ | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0018556980001 | 05 | PA | MEDICAID |