Provider Demographics
NPI:1417999764
Name:JABER, RAJA (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJA
Middle Name:
Last Name:JABER
Suffix:
Gender:F
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 1559
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0989
Mailing Address - Country:US
Mailing Address - Phone:631-444-6250
Mailing Address - Fax:631-444-6665
Practice Address - Street 1:2500 NESCONSET HWY
Practice Address - Street 2:BLD 16
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2555
Practice Address - Country:US
Practice Address - Phone:631-444-6250
Practice Address - Fax:631-444-6665
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164456207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY4307709OtherAETNA
NY47F501OtherEMPIRE BC.BS
NY01052184Medicaid
NY01052184Medicaid
NY47F501Medicare ID - Type Unspecified