Healthcare Provider Details

I. General information

NPI: 1134889439
Provider Name (Legal Business Name): RAJ GLOBAL HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2021
Last Update Date: 12/31/2021
Certification Date: 12/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 BLACKWOOD CLEMENTON RD
CLEMENTON NJ
08021-3854
US

IV. Provider business mailing address

76 BLACKWOOD CLEMENTON RD
CLEMENTON NJ
08021-3854
US

V. Phone/Fax

Practice location:
  • Phone: 856-600-1451
  • Fax:
Mailing address:
  • Phone: 856-600-1451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MARINDA NAYELI WALLER
Title or Position: VICE PRESIDENT
Credential:
Phone: 856-600-1451