Healthcare Provider Details

I. General information

NPI: 1821230004
Provider Name (Legal Business Name): SREEDAR RAJA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CENTURY DR
PARSIPPANY NJ
07054-4610
US

IV. Provider business mailing address

26 WEXFORD DR
MONMOUTH JUNCTION NJ
08852-2714
US

V. Phone/Fax

Practice location:
  • Phone: 215-798-0003
  • Fax:
Mailing address:
  • Phone: 732-329-0345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MA09062300
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number25MA09062300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: