1316108368 NPI number — RAJARAMAN MEDICINE & PEDIATRICS, LLC

Table of content: (NPI 1316108368)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316108368 NPI number — RAJARAMAN MEDICINE & PEDIATRICS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAJARAMAN MEDICINE & PEDIATRICS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316108368
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 NOTTINGHAM RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MORGANVILLE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07751-9518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-591-1294
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
59 AVENUE AT THE CMN
Provider Second Line Business Practice Location Address:
SUITE#105
Provider Business Practice Location Address City Name:
SHREWSBURY
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07702-4806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-544-8899
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RAJARAMAN
Authorized Official First Name:
RAVINDRAN
Authorized Official Middle Name:
THIRUNAVU
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
732-544-8899

Provider Taxonomy Codes

  • Taxonomy code: 261QM1300X , with the licence number:  25MA07526600 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 091285W7 . This is a "MEDICARE PERSONAL" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0066613 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".