Provider Demographics
NPI:1174719124
Name:RAJAN, SAMIR (MD)
Entity type:Individual
Prefix:
First Name:SAMIR
Middle Name:
Last Name:RAJAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 E JULIUS ST
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2604
Mailing Address - Country:US
Mailing Address - Phone:908-208-4306
Mailing Address - Fax:
Practice Address - Street 1:2177 OAK TREE RD
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1082
Practice Address - Country:US
Practice Address - Phone:908-769-4735
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-23
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08304500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0160202Medicaid
NJ192416ZC8AMedicare PIN
NJ192416ZC79Medicare PIN