Healthcare Provider Details

I. General information

NPI: 1619035342
Provider Name (Legal Business Name): RAMCHAND THADHANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 S NEW YORK RD SUITE C 4
GALLOWAY NJ
08205-9695
US

IV. Provider business mailing address

28 S NEW YORK RD SUITE C 4
GALLOWAY NJ
08205-9695
US

V. Phone/Fax

Practice location:
  • Phone: 609-652-0555
  • Fax: 609-652-1414
Mailing address:
  • Phone: 609-652-0555
  • Fax: 609-652-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number25MA06572700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: