Provider Demographics
NPI:1508879792
Name:SU-RAJ CORP
Entity Type:Organization
Organization Name:SU-RAJ CORP
Other - Org Name:MEDICAL DIAGNOSTIC LABORATORIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:856-786-4222
Mailing Address - Street 1:101 RT 130 S
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077
Mailing Address - Country:US
Mailing Address - Phone:856-786-4222
Mailing Address - Fax:856-786-4333
Practice Address - Street 1:101 RT 130 S
Practice Address - Street 2:SUITE 401
Practice Address - City:CINNAMINSON
Practice Address - State:NJ
Practice Address - Zip Code:08077
Practice Address - Country:US
Practice Address - Phone:856-786-4222
Practice Address - Fax:856-786-4333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ39DO719734291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5596904Medicaid
307732Medicare ID - Type Unspecified