Individual
KETEVAN GOGIDZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1199 PLEASANT VALLEY WAY, WEST ORANGE, NJ 07052-1424
(973) 731-3600
Mailing address
15 BLAINE ST, MILLBURN, NJ 07041-1308
(862) 215-7558
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
26NR12871200
NJ
Other
Enumeration date
04/11/2026
Last updated
04/11/2026
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