Provider Demographics
NPI:1508804345
Name:UPPAL, RAJIV (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJIV
Middle Name:
Last Name:UPPAL
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 1:142 ROUTE 35 S
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-1876
Mailing Address - Country:US
Mailing Address - Phone:732-389-1744
Mailing Address - Fax:732-389-1850
Practice Address - Street 1:142 ROUTE 35
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-3427
Practice Address - Country:US
Practice Address - Phone:732-389-5004
Practice Address - Fax:732-389-1850
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA48200207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5001102Medicaid
NJ5001102Medicaid
NJ549155C1JMedicare PIN