Provider Demographics
NPI:1629573845
Name:GOLANI, JONATHAN AVIV (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:AVIV
Last Name:GOLANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 419430
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-9430
Mailing Address - Country:US
Mailing Address - Phone:201-967-8221
Mailing Address - Fax:201-483-2242
Practice Address - Street 1:1129 BLOOMFIELD AVE STE 100
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-7123
Practice Address - Country:US
Practice Address - Phone:973-429-6864
Practice Address - Fax:973-521-7888
Is Sole Proprietor?:No
Enumeration Date:2018-03-28
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA11253800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine