Provider Demographics
NPI:1659559219
Name:RAINBOW MEDICAL ASSOCIATION MD PA
Entity Type:Organization
Organization Name:RAINBOW MEDICAL ASSOCIATION MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAJYALAKSHMI
Authorized Official - Middle Name:V
Authorized Official - Last Name:VADALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-679-0660
Mailing Address - Street 1:1 IRENE CT
Mailing Address - Street 2:
Mailing Address - City:OLD BRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08857-2705
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:732-679-7177
Practice Address - Street 1:1 IRENE CT
Practice Address - Street 2:
Practice Address - City:OLD BRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08857-2705
Practice Address - Country:US
Practice Address - Phone:732-679-0660
Practice Address - Fax:732-679-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty