MEDICARE: RASIK M. JIVANI MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MA55789	NJ

General Provider Information

NPI Number	:	1801051818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RASIK M. JIVANI MD PA

Provider Business Mailing Address
First Line	:	611 ROUTE 539
Second Line	:
City	:	CREAM RIDGE
State	:	NJ
Zip	:	08514-2334
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	611 ROUTE 539
Second Line	:
City	:	CREAM RIDGE
State	:	NJ
Zip	:	08514-2334
Country	:	US
Telephone Number	:	609-758-3200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RASIK M. JIVANI
Credential	:	MD, PA
Telephone Number	:	609-758-3200

Provider Enumeration Date	:	07/20/2008
Last Update Date	:	07/20/2008

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