Healthcare Provider Details

I. General information

NPI: 1831341791
Provider Name (Legal Business Name): RAJIT BHOOSA MALLIAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PROSPECT AVE
HACKENSACK NJ
07601-1915
US

IV. Provider business mailing address

904 RIVER RD
PISCATAWAY NJ
08854-5504
US

V. Phone/Fax

Practice location:
  • Phone: 732-330-9637
  • Fax:
Mailing address:
  • Phone: 732-330-9637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number25MA08082900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: