Provider Demographics
NPI:1154309037
Name:MARIWALLA, RAJKUMAR G (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJKUMAR
Middle Name:G
Last Name:MARIWALLA
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1111 MONTAUK HWY
Mailing Address - Street 2:SUITE #3-1
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4910
Mailing Address - Country:US
Mailing Address - Phone:631-669-1171
Mailing Address - Fax:631-669-1912
Practice Address - Street 1:1175 MONTAUK HWY
Practice Address - Street 2:SUITE #3
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4939
Practice Address - Country:US
Practice Address - Phone:631-669-1171
Practice Address - Fax:631-669-1912
Is Sole Proprietor?:No
Enumeration Date:2006-01-02
Last Update Date:2014-01-08
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Provider Licenses
StateLicense IDTaxonomies
NY143127207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology