Basic Information
| Provider Information | |||||||||
| NPI: | 1629573845 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLANI | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | AVIV | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 419430 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022419430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2019678221 | ||||||||
| FaxNumber: | 2014832242 | ||||||||
| Practice Location | |||||||||
| Address1: | 1129 BLOOMFIELD AVE STE 100 | ||||||||
| Address2: | |||||||||
| City: | WEST CALDWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070067123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9734296864 | ||||||||
| FaxNumber: | 9735217888 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2018 | ||||||||
| LastUpdateDate: | 10/29/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 25MA11253800 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.