1912968728 NPI number — DR. RAJNEESH NATH MD

Table of content: DR. RAJNEESH NATH MD (NPI 1912968728)

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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