1871580191 NPI number — RAJ PHYSICAL REHABILITATION CENTER,P.A.

Table of content: (NPI 1871580191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871580191 NPI number — RAJ PHYSICAL REHABILITATION CENTER,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAJ PHYSICAL REHABILITATION CENTER,P.A.
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:
RAJ REHAB
Provider Other Organization Name Type Code:
5
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:
1871580191
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6200 W ATLANTIC AVE
Provider Second Line Business Mailing Address:
#201
Provider Business Mailing Address City Name:
DELRAY BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33484-3501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-499-3041
Provider Business Mailing Address Fax Number:
561-499-3042

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6200 W ATLANTIC AVE
Provider Second Line Business Practice Location Address:
#201
Provider Business Practice Location Address City Name:
DELRAY BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33484-3501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-499-3041
Provider Business Practice Location Address Fax Number:
561-499-3042
Provider Enumeration Date:
10/03/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TIRUVALAM
Authorized Official First Name:
NAGARAJA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-499-3041

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Y923C . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 6697451 . This is a "GHI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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