Healthcare Provider Details

I. General information

NPI: 1568154664
Provider Name (Legal Business Name): FELICIA M RAJU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

466 OLD HOOK RD STE 1
EMERSON NJ
07630-1368
US

IV. Provider business mailing address

466 OLD HOOK RD STE 1
EMERSON NJ
07630-1368
US

V. Phone/Fax

Practice location:
  • Phone: 201-967-8221
  • Fax: 201-967-0340
Mailing address:
  • Phone: 201-967-8221
  • Fax: 201-967-0340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MB13029700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: