Provider Demographics
NPI:1245224039
Name:UDANI, RAJEN I (MD)
Entity Type:Individual
Prefix:
First Name:RAJEN
Middle Name:I
Last Name:UDANI
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 1:155 MEDICAL CENTER WAY FL 3
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2306
Mailing Address - Country:US
Mailing Address - Phone:856-383-3221
Mailing Address - Fax:
Practice Address - Street 1:217 NORTH MAIN STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:CAPE MAY COURT
Practice Address - State:NJ
Practice Address - Zip Code:08210-2165
Practice Address - Country:US
Practice Address - Phone:609-465-2001
Practice Address - Fax:609-465-8440
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04189700207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ56831OtherAETNA LIFE INS
NJ223240917OtherHORIZON BC BS OF NJ
NJ1928104Medicaid
NJ0108415000OtherAMERIHEALTH
NJ56831OtherAETNA LIFE INS