Healthcare Provider Details

I. General information

NPI: 1265476576
Provider Name (Legal Business Name): RASIK JIVANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 05/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 ROUTE 539
CREAM RIDGE NJ
08514-2334
US

IV. Provider business mailing address

51 JOSEPH ST
MANALAPAN NJ
07726-8332
US

V. Phone/Fax

Practice location:
  • Phone: 609-758-3200
  • Fax:
Mailing address:
  • Phone: 732-866-3932
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA55789
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: