Provider Demographics
NPI:1457377491
Name:SHARMA, RAJ KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:RAJ
Middle Name:KUMAR
Last Name:SHARMA
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 1:15 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-5007
Mailing Address - Country:US
Mailing Address - Phone:973-473-1180
Mailing Address - Fax:973-815-0747
Practice Address - Street 1:15 BROADWAY
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055-5007
Practice Address - Country:US
Practice Address - Phone:973-473-1180
Practice Address - Fax:973-815-0747
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA02746900208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA02746900OtherLICENSE
NJ2922002Medicaid
NJ2922002Medicaid
NJ118613Medicare ID - Type Unspecified