Provider Demographics
NPI:1568742955
Name:RAJAN, SAJU MATHEW (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SAJU
Middle Name:MATHEW
Last Name:RAJAN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 LOCUSTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-1411
Mailing Address - Country:US
Mailing Address - Phone:516-554-2595
Mailing Address - Fax:
Practice Address - Street 1:82 LOCUSTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-1411
Practice Address - Country:US
Practice Address - Phone:516-554-2595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055880183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist