Provider Demographics
NPI:1700224557
Name:RAJAN, RENJINI (AANP-C, GANP-C)
Entity Type:Individual
Prefix:MS
First Name:RENJINI
Middle Name:
Last Name:RAJAN
Suffix:
Gender:F
Credentials:AANP-C, GANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 MADISON AVE
Mailing Address - Street 2:APT 74
Mailing Address - City:NEW MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07646-1370
Mailing Address - Country:US
Mailing Address - Phone:201-926-9384
Mailing Address - Fax:
Practice Address - Street 1:510 HAMBURG TPKE STE 101
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-2033
Practice Address - Country:US
Practice Address - Phone:973-653-9485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00449000363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology