Provider Demographics
NPI:1477973766
Name:MADRASWALA, REHMAN (MD)
Entity Type:Individual
Prefix:
First Name:REHMAN
Middle Name:
Last Name:MADRASWALA
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 1:551 PARK AVENUE
Mailing Address - Street 2:SUITE 3C BOX 8
Mailing Address - City:SCOTCH PLAINS
Mailing Address - State:NJ
Mailing Address - Zip Code:07076
Mailing Address - Country:US
Mailing Address - Phone:908-455-8120
Mailing Address - Fax:908-455-8122
Practice Address - Street 1:551 PARK AVE STE 3C
Practice Address - Street 2:
Practice Address - City:SCOTCH PLAINS
Practice Address - State:NJ
Practice Address - Zip Code:07076
Practice Address - Country:US
Practice Address - Phone:908-455-8120
Practice Address - Fax:908-455-8122
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXR07492084P0800X
NJ25MA098790002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry