Provider Demographics
NPI:1477566222
Name:MAHALINGAM, RAJESHWARI
Entity Type:Individual
Prefix:
First Name:RAJESHWARI
Middle Name:
Last Name:MAHALINGAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 WEST GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0713
Practice Address - Street 1:97 PATERSON ST
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901-2160
Practice Address - Country:US
Practice Address - Phone:732-235-6230
Practice Address - Fax:732-235-8766
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA747492084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0032808Medicaid
NJ076883Medicare ID - Type Unspecified
NJ0032808Medicaid
NJI02003Medicare UPIN