Individual
COLLEEN KHATIWALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3205 FIRE RD, EGG HARBOR TOWNSHIP, NJ 08234-5884
(609) 407-1113
Mailing address
PO BOX 48076, NEWARK, NJ 07101-4876
(201) 804-2800
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
25MA08406300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
25MA08406300
STATE LICENSE
NJ
Enumeration date
10/09/2008
Last updated
10/09/2008
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