Healthcare Provider Details

I. General information

NPI: 1598355521
Provider Name (Legal Business Name): BIRJU RAO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2021
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 EDGEWATER TOWNE CTR
EDGEWATER NJ
07020-1246
US

IV. Provider business mailing address

331 NEWMAN SPRINGS RD STE 220
RED BANK NJ
07701-5792
US

V. Phone/Fax

Practice location:
  • Phone: 888-663-6331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number026295
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: