Provider Demographics
NPI:1801051818
Name:RASIK M. JIVANI MD PA
Entity type:Organization
Organization Name:RASIK M. JIVANI MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RASIK
Authorized Official - Middle Name:M
Authorized Official - Last Name:JIVANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:609-758-3200
Mailing Address - Street 1:611 ROUTE 539
Mailing Address - Street 2:
Mailing Address - City:CREAM RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:08514-2334
Mailing Address - Country:US
Mailing Address - Phone:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-20
Last Update Date:2008-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA55789207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty