1649565987 NPI number — DR. RAHUL GURBUX MATNANI

Table of content: DR. DAVID LEONARD HARSHMAN M.D. (NPI 1326152786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649565987 NPI number — DR. RAHUL GURBUX MATNANI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATNANI
Provider First Name:
RAHUL
Provider Middle Name:
GURBUX
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MATNANI
Provider Other First Name:
RAHUL
Provider Other Middle Name:
GURBAKSH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MBBS, PHD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1649565987
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 ROUTE 17 FL 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUTHERFORD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07070-2597
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-528-9200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 ROUTE 17 FL 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUTHERFORD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-528-9200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2011

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: 207ZP0102X , with the licence number:  25MA10134400 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZH0000X , with the licence number: 25MA10134400 , 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)