Healthcare Provider Details

I. General information

NPI: 1912006982
Provider Name (Legal Business Name): LILLY P RATHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

442 A BORDENTOWN AVENUE LILLY P RATHI MD
SOUTH AMBOY NJ
08879
US

IV. Provider business mailing address

442 A BORDENTOWN AVENUE LILLY P RATHI MD
SOUTH AMBOY NJ
08879
US

V. Phone/Fax

Practice location:
  • Phone: 732-727-6777
  • Fax: 732-422-4129
Mailing address:
  • Phone: 732-727-6777
  • Fax: 732-422-4129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number04014200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: