Provider Demographics
NPI:1942475603
Name:ANDREW B. RAJAPAKSE, MD PA
Entity Type:Organization
Organization Name:ANDREW B. RAJAPAKSE, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:B
Authorized Official - Last Name:RAJAPAKSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-634-8483
Mailing Address - Street 1:107 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-2910
Mailing Address - Country:US
Mailing Address - Phone:732-634-8483
Mailing Address - Fax:732-634-8626
Practice Address - Street 1:107 GREEN ST
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-2910
Practice Address - Country:US
Practice Address - Phone:732-634-8483
Practice Address - Fax:732-634-8626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-24
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA028742207Q00000X
NJ25MA08277300NJ207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1877704Medicaid
C55755Medicare UPIN
NJ1877704Medicaid