Healthcare Provider Details

I. General information

NPI: 1861652885
Provider Name (Legal Business Name): RAJALAKSHMI SESHAMANI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 LONGFORD CT
WARREN NJ
07059-6766
US

IV. Provider business mailing address

5 LONGFORD CT
WARREN NJ
07059-6766
US

V. Phone/Fax

Practice location:
  • Phone: 908-647-5513
  • Fax:
Mailing address:
  • Phone: 908-647-5513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA03075700
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: