Provider Demographics
NPI:1649565987
Name:MATNANI, RAHUL GURBUX
Entity Type:Individual
Prefix:DR
First Name:RAHUL
Middle Name:GURBUX
Last Name:MATNANI
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:RAHUL
Other - Middle Name:GURBAKSH
Other - Last Name:MATNANI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MBBS, PHD
Mailing Address - Street 1:201 ROUTE 17 FL 2
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07070-2597
Mailing Address - Country:US
Mailing Address - Phone:201-528-9200
Mailing Address - Fax:
Practice Address - Street 1:201 ROUTE 17 FL 2
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070
Practice Address - Country:US
Practice Address - Phone:201-528-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-15
Last Update Date:2018-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10134400207ZP0102X, 207ZH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology