Provider Demographics
NPI:1851676936
Name:JOHN S. RAJAPAKSE, MD PA
Entity Type:Organization
Organization Name:JOHN S. RAJAPAKSE, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:RAJAPAKSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-442-4422
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-20
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0282773000207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0140449Medicaid
124071X9NMedicare PIN