Provider Demographics
NPI:1639377914
Name:RAJAPAKSE, JOHN SENEKA (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:SENEKA
Last Name:RAJAPAKSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:495 NEW BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:PERTH AMBOY
Mailing Address - State:NJ
Mailing Address - Zip Code:08861-3653
Mailing Address - Country:US
Mailing Address - Phone:732-442-4422
Mailing Address - Fax:732-442-3577
Practice Address - Street 1:495 NEW BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:PERTH AMBOY
Practice Address - State:NJ
Practice Address - Zip Code:08861-3653
Practice Address - Country:US
Practice Address - Phone:732-442-4422
Practice Address - Fax:732-442-3577
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08277300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ124071X9NMedicare PIN