1184888091 NPI number — RAJASHREE KANTHA, M.D., P.A.

Table of content: LAURA ROSE SULLIVAN (NPI 1942991187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184888091 NPI number — RAJASHREE KANTHA, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAJASHREE KANTHA, M.D., 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:
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:
1184888091
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1124 E RIDGEWOOD AVE STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIDGEWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07450-3943
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-445-7744
Provider Business Mailing Address Fax Number:
201-445-7767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1124 E RIDGEWOOD AVE STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGEWOOD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07450-3943
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-445-7744
Provider Business Practice Location Address Fax Number:
201-445-7767
Provider Enumeration Date:
07/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KANTHA
Authorized Official First Name:
RAJASHREE
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
201-445-7744

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  25MA07366300 , 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: 0110617 . This is a "GHI" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com