Provider Demographics
NPI:1558362202
Name:GUJJA, RAJITHA R (MD)
Entity Type:Individual
Prefix:
First Name:RAJITHA
Middle Name:R
Last Name:GUJJA
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 419430
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-9430
Mailing Address - Country:US
Mailing Address - Phone:201-967-8221
Mailing Address - Fax:201-483-2242
Practice Address - Street 1:239 CLAREMONT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2833
Practice Address - Country:US
Practice Address - Phone:973-338-4900
Practice Address - Fax:973-338-4420
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07684900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0033243Medicaid
NJ0033243Medicaid
I09898Medicare UPIN