Provider Demographics
NPI:1639256068
Name:RAWAL, DEWANG H (PA - C)
Entity Type:Individual
Prefix:MR
First Name:DEWANG
Middle Name:H
Last Name:RAWAL
Suffix:
Gender:M
Credentials:PA - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HOFFMAN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE HIAWATHA
Mailing Address - State:NJ
Mailing Address - Zip Code:07034-2320
Mailing Address - Country:US
Mailing Address - Phone:917-864-8957
Mailing Address - Fax:
Practice Address - Street 1:15 HOFFMAN AVE
Practice Address - Street 2:
Practice Address - City:LAKE HIAWATHA
Practice Address - State:NJ
Practice Address - Zip Code:07034-2320
Practice Address - Country:US
Practice Address - Phone:917-864-8957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00235200363A00000X
NY013793-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant