Healthcare Provider Details

I. General information

NPI: 1396855854
Provider Name (Legal Business Name): RAJALAKSHMI NANDAKUMAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KNOLLCROFT RD VA NJHCS - DEPT AMBULATORY CARE
LYONS NJ
07939
US

IV. Provider business mailing address

KNOLLCROFT RD VA NJHCS - DEPT AMBULATORY CARE
LYONS NJ
07939
US

V. Phone/Fax

Practice location:
  • Phone: 908-647-0180
  • Fax: 908-647-6367
Mailing address:
  • Phone: 908-647-0180
  • Fax: 908-647-6367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMA03809200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: