Provider Demographics
NPI:1275550915
Name:PASSI, RAKESH (MD,)
Entity Type:Individual
Prefix:DR
First Name:RAKESH
Middle Name:
Last Name:PASSI
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:PO BOX 685
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-0685
Mailing Address - Country:US
Mailing Address - Phone:732-238-6440
Mailing Address - Fax:732-238-2566
Practice Address - Street 1:172 SUMMERHILL RD STE 5
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-4911
Practice Address - Country:US
Practice Address - Phone:732-238-6440
Practice Address - Fax:732-238-2566
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06398600207RA0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3143929OtherAETNA
NJP683793OtherOXFORD
NJ7068107Medicaid
NJP683793OtherOXFORD
NJ7068107Medicaid