Provider Demographics
NPI:1952646408
Name:JAIN, RAKESH (CPO)
Entity Type:Individual
Prefix:MR
First Name:RAKESH
Middle Name:
Last Name:JAIN
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CALVERT AVE E
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3827
Mailing Address - Country:US
Mailing Address - Phone:201-774-1085
Mailing Address - Fax:
Practice Address - Street 1:107 CALVERT AVE E
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3827
Practice Address - Country:US
Practice Address - Phone:201-774-1085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ45PO00007000332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment