Healthcare Provider Details

I. General information

NPI: 1619200748
Provider Name (Legal Business Name): SANJAY D RAO MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 WESCOTT DRIVE
FLEMINGTON NJ
08822-4603
US

IV. Provider business mailing address

PO BOX 622
FRANKLIN LAKES NJ
07417-0622
US

V. Phone/Fax

Practice location:
  • Phone: 908-788-6160
  • Fax:
Mailing address:
  • Phone: 908-300-3700
  • Fax: 201-847-0059

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number25MA08158000
License Number StateNJ

VIII. Authorized Official

Name: DR. SANJAY D RAO
Title or Position: SOLE PROP
Credential: MD
Phone: 917-846-4049