Provider Demographics
NPI:1891572665
Name:RAJA, MOHAMMAD HANIF
Entity Type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:HANIF
Last Name:RAJA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 LYONS AVE FL 1
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07112-1440
Mailing Address - Country:US
Mailing Address - Phone:646-591-4779
Mailing Address - Fax:
Practice Address - Street 1:1002 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08817-4899
Practice Address - Country:US
Practice Address - Phone:732-515-9027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI04308400183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist