1912968728 NPI number — DR. RAJNEESH NATH MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912968728 NPI number — DR. RAJNEESH NATH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NATH
Provider First Name:
RAJNEESH
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NATH
Provider Other First Name:
RAJNEESH
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1912968728
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 LAKE AVE N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01655-0002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
774-442-3903
Provider Business Mailing Address Fax Number:
774-443-7890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 LITTLE ALBANY STREET, 9TH FLOOR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRUNSWICK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
08901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-235-2465
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  237787 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 25MA07376000 , 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: 1912968728 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: PVN 1935556 . This is a "AETNA US HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1912968728 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1912968728 . This is a "MEDICARE CT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2160536 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000765501 . This is a "MEDICARE PART B" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1015504 . This is a "MEDICARE VT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1912968728 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: RN 72782 . This is a "MEDICARE RI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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