Provider Demographics
NPI:1922547769
Name:RAJ MEDICAL DIAGNOSTICS PC
Entity Type:Organization
Organization Name:RAJ MEDICAL DIAGNOSTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RACQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:917-940-0360
Mailing Address - Street 1:887 RUTLAND RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11203-1911
Mailing Address - Country:US
Mailing Address - Phone:917-940-0360
Mailing Address - Fax:
Practice Address - Street 1:3180 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-4237
Practice Address - Country:US
Practice Address - Phone:917-940-0360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RAJ MEDICAL DIAGNOSTICS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-02-13
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT55603207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty