Healthcare Provider Details

I. General information

NPI: 1184001927
Provider Name (Legal Business Name): RUCHI RAWAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2015
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 RIVER RD
EDGEWATER NJ
07020-1171
US

IV. Provider business mailing address

725 RIVER RD
EDGEWATER NJ
07020-1171
US

V. Phone/Fax

Practice location:
  • Phone: 551-313-7865
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA11151400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: