Provider Demographics
NPI:1265476576
Name:JIVANI, RASIK (MD)
Entity type:Individual
Prefix:DR
First Name:RASIK
Middle Name:
Last Name:JIVANI
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 1:51 JOSEPH ST
Mailing Address - Street 2:
Mailing Address - City:MANALAPAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8332
Mailing Address - Country:US
Mailing Address - Phone:732-866-3932
Mailing Address - Fax:
Practice Address - Street 1:611 ROUTE 539
Practice Address - Street 2:
Practice Address - City:CREAM RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:08514-2334
Practice Address - Country:US
Practice Address - Phone:609-758-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA55789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJJI717372Medicare ID - Type Unspecified
NJF22241Medicare UPIN