Provider Demographics
NPI:1902840556
Name:RAPPAI, JAMES KIDANGAN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KIDANGAN
Last Name:RAPPAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 S EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2739
Mailing Address - Country:US
Mailing Address - Phone:856-686-4300
Mailing Address - Fax:
Practice Address - Street 1:1200 PARK AVE
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07061
Practice Address - Country:US
Practice Address - Phone:908-668-2200
Practice Address - Fax:908-668-6894
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA61429207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9009906Medicaid
NJ065570Medicare ID - Type Unspecified
NJ9009906Medicaid